Healthcare Provider Details

I. General information

NPI: 1982773016
Provider Name (Legal Business Name): KAREN ABBY ILGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 WELLINGTON DR
CHARLESTON SC
29412-4846
US

IV. Provider business mailing address

1152 WELLINGTON DR
CHARLESTON SC
29412-4846
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number610
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: