Healthcare Provider Details

I. General information

NPI: 1487866604
Provider Name (Legal Business Name): SHERI HOWLE FIDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERI R BAUGHMAN

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PROFESSIONAL PARK DR
CONWAY SC
29526-9261
US

IV. Provider business mailing address

103 PROFESSIONAL PARK DR
CONWAY SC
29526-9261
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax: 843-353-3461
Mailing address:
  • Phone: 843-353-3460
  • Fax: 843-353-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2204
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: