Healthcare Provider Details

I. General information

NPI: 1124743976
Provider Name (Legal Business Name): KATHLEEN MARIE GRABOWSKI SC HAS #0684
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 08/29/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E N B BAROODY ST
FLORENCE SC
29506-2523
US

IV. Provider business mailing address

4460 SALEM RD
AYNOR SC
29511-4964
US

V. Phone/Fax

Practice location:
  • Phone: 843-662-7802
  • Fax:
Mailing address:
  • Phone: 843-504-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0684
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: