Healthcare Provider Details

I. General information

NPI: 1962365692
Provider Name (Legal Business Name): ADDISON POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 MARINA DR
CHARLESTON SC
29492-8093
US

IV. Provider business mailing address

9204 PINK FROST RD
MONCKS CORNER SC
29461-9116
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: