Healthcare Provider Details

I. General information

NPI: 1609085166
Provider Name (Legal Business Name): AUBREY ELIZABETH SHIELDS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUBREY ELIZABETH TOWNER OTRL

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MARSHALL RD
GREENWOOD SC
29646-4216
US

IV. Provider business mailing address

118 RED FOX CT
CLARKS HILL SC
29821-2112
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-7272
  • Fax:
Mailing address:
  • Phone: 803-279-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2848
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: