Healthcare Provider Details

I. General information

NPI: 1659800266
Provider Name (Legal Business Name): DEVELOPING ABILITIES CHILDREN'S THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GALSWORTHY DR
GOOSE CREEK SC
29445-7025
US

IV. Provider business mailing address

105 GALSWORTHY DR
GOOSE CREEK SC
29445-7025
US

V. Phone/Fax

Practice location:
  • Phone: 843-345-6402
  • Fax: 843-569-0550
Mailing address:
  • Phone: 843-345-6402
  • Fax: 843-569-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number518
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierTH007
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MS. MONICA KEEN
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential: MS, OTR/L
Phone: 843-345-6402