Healthcare Provider Details

I. General information

NPI: 1750209185
Provider Name (Legal Business Name): KAITLYN QUIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST STE 710
CHARLESTON SC
29403-5785
US

IV. Provider business mailing address

169 ASHLEY AVE
CHARLESTON SC
29425-0100
US

V. Phone/Fax

Practice location:
  • Phone: 854-222-2235
  • Fax:
Mailing address:
  • Phone: 843-792-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7765
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: