Healthcare Provider Details

I. General information

NPI: 1235285958
Provider Name (Legal Business Name): ANNE E. GUADARRAMA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE E COLLIER OT

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 THE PKWY
GREER SC
29650-5204
US

IV. Provider business mailing address

376 STRASBURG DR
SIMPSONVILLE SC
29681-4562
US

V. Phone/Fax

Practice location:
  • Phone: 864-244-3474
  • Fax: 864-244-3475
Mailing address:
  • Phone: 864-430-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16854
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3039
License Number StateSC

VII. Legacy identifiers

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

# 1
IdentifierTH1608
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: