Healthcare Provider Details

I. General information

NPI: 1184547895
Provider Name (Legal Business Name): MARA R CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N BELTLINE DR STE C
FLORENCE SC
29501-7420
US

IV. Provider business mailing address

315 N BELTLINE DR STE C
FLORENCE SC
29501-7420
US

V. Phone/Fax

Practice location:
  • Phone: 843-731-9186
  • Fax: 843-351-6457
Mailing address:
  • Phone: 843-731-9186
  • Fax: 843-351-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: