Healthcare Provider Details

I. General information

NPI: 1891408316
Provider Name (Legal Business Name): ELAINA MICHELLE BURGESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 ASHLEY RIVER RD STE I
CHARLESTON SC
29407-4904
US

IV. Provider business mailing address

1954 ASHLEY RIVER RD STE I
CHARLESTON SC
29407-4904
US

V. Phone/Fax

Practice location:
  • Phone: 843-225-5825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7459
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15583
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: