Healthcare Provider Details

I. General information

NPI: 1376387738
Provider Name (Legal Business Name): EMILY RYAN BOTT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 FOLLY RD
CHARLESTON SC
29412-4114
US

IV. Provider business mailing address

85C VINCENT DR
MOUNT PLEASANT SC
29464-4030
US

V. Phone/Fax

Practice location:
  • Phone: 843-822-2292
  • Fax:
Mailing address:
  • Phone: 843-822-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7229
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: