Healthcare Provider Details

I. General information

NPI: 1295517894
Provider Name (Legal Business Name): MRS. DYLAN D BONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DYLAN T DEJAMES

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 COVENANT RD
COLUMBIA SC
29204-4216
US

IV. Provider business mailing address

2514 BURNEY DR
COLUMBIA SC
29205-3117
US

V. Phone/Fax

Practice location:
  • Phone: 803-787-3033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number.7034
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: