Healthcare Provider Details

I. General information

NPI: 1548196066
Provider Name (Legal Business Name): SARAH ELIZABETH KELLEY OTD R/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 COMMERCIAL CENTER DR
LADSON SC
29456-4146
US

IV. Provider business mailing address

3851 COMMERCIAL CENTER DR
LADSON SC
29456-4146
US

V. Phone/Fax

Practice location:
  • Phone: 888-510-6369
  • Fax:
Mailing address:
  • Phone: 888-510-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7974
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: