Healthcare Provider Details

I. General information

NPI: 1619345824
Provider Name (Legal Business Name): KID WORKS OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 SAVANNAH HWY STE 3
CHARLESTON SC
29407-7820
US

IV. Provider business mailing address

1152 WELLINGTON DR
CHARLESTON SC
29412-4846
US

V. Phone/Fax

Practice location:
  • Phone: 843-991-2694
  • Fax: 843-405-1316
Mailing address:
  • Phone: 843-991-2694
  • Fax: 843-405-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KAREN A ILGEN
Title or Position: MEMBER
Credential: OTR/L
Phone: 843-991-2694