Healthcare Provider Details

I. General information

NPI: 1609554641
Provider Name (Legal Business Name): MONA REBECCA PATTERSON- FOSTER THERAPEUTIC SHOE FIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9153 TWO NOTCH RD STE C
COLUMBIA SC
29223-5853
US

IV. Provider business mailing address

9153 TWO NOTCH RD STE C
COLUMBIA SC
29223-5853
US

V. Phone/Fax

Practice location:
  • Phone: 803-394-4421
  • Fax:
Mailing address:
  • Phone: 803-394-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: