Healthcare Provider Details

I. General information

NPI: 1831323468
Provider Name (Legal Business Name): SUNSHINE PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N WOODLAKE DR
COLUMBIA SC
29229-8933
US

IV. Provider business mailing address

303 N WOODLAKE DR
COLUMBIA SC
29229-8933
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-2092
  • Fax: 803-736-2092
Mailing address:
  • Phone: 803-736-2092
  • Fax: 803-736-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number571
License Number StateSC

VIII. Authorized Official

Name: MRS. ANDREA NEIMAN DENT
Title or Position: OWNER/ OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 803-736-2092