Healthcare Provider Details

I. General information

NPI: 1023797289
Provider Name (Legal Business Name): KANDIS DUNBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ELMWOOD AVE STE 101
COLUMBIA SC
29201-2058
US

IV. Provider business mailing address

3635 TRUMAN ST
COLUMBIA SC
29204-1615
US

V. Phone/Fax

Practice location:
  • Phone: 803-250-6833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: