Healthcare Provider Details

I. General information

NPI: 1841381357
Provider Name (Legal Business Name): ARTHUR YEAGER OTR L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 STUART ST MONCRIEF ARMY COMMUNITY HOSPITAL/CREDENTIALS
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

225 COTTONWOOD WAY
COLUMBIA SC
29229-9190
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-0650
  • Fax:
Mailing address:
  • Phone: 803-234-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC008804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: