Healthcare Provider Details

I. General information

NPI: 1770532541
Provider Name (Legal Business Name): PRISCILLA ELISABETH SMITH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRISCILLA ELISABETH MYERS OTR/L

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 GOLF COURSE RD
HARTSVILLE SC
29550-3037
US

IV. Provider business mailing address

105 YAUPON DR
HARTSVILLE SC
29550
US

V. Phone/Fax

Practice location:
  • Phone: 843-339-9639
  • Fax:
Mailing address:
  • Phone: 843-319-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3941
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2231
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: