Healthcare Provider Details

I. General information

NPI: 1770399339
Provider Name (Legal Business Name): KATHERINE TURNER CHILDREY OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 MARINA DR STE 104
CHARLESTON SC
29492-9084
US

IV. Provider business mailing address

1532 TELFAIR WAY
CHARLESTON SC
29412-2382
US

V. Phone/Fax

Practice location:
  • Phone: 843-806-3110
  • Fax:
Mailing address:
  • Phone: 919-906-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7408
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7408
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: