Healthcare Provider Details

I. General information

NPI: 1679484687
Provider Name (Legal Business Name): IMANI WESTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MALLORY DR
GOOSE CREEK SC
29445-6406
US

IV. Provider business mailing address

PO BOX 1119
GOOSE CREEK SC
29445-1119
US

V. Phone/Fax

Practice location:
  • Phone: 843-996-1471
  • Fax: 843-808-6986
Mailing address:
  • Phone: 843-996-1471
  • Fax: 843-808-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7802
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: