Healthcare Provider Details

I. General information

NPI: 1669484093
Provider Name (Legal Business Name): COURTNEY E JARRARD OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

1045 MATHIS FERRY RD
MT PLEASANT SC
29464-2616
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3481
  • Fax:
Mailing address:
  • Phone: 843-568-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2776
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: