Healthcare Provider Details

I. General information

NPI: 1154430668
Provider Name (Legal Business Name): SARAH GASSMAN WILBANKS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 FOLLY RD
CHARLESTON SC
29412-2625
US

IV. Provider business mailing address

9 N BASILICA AVE
HANAHAN SC
29410-8649
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-3601
  • Fax: 843-762-7074
Mailing address:
  • Phone: 843-478-4047
  • Fax: 843-762-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1567
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: