Healthcare Provider Details

I. General information

NPI: 1265733125
Provider Name (Legal Business Name): JASON KUPIEC DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 HIGHWAY 78
LADSON SC
29456-3966
US

IV. Provider business mailing address

9525 HIGHWAY 78
LADSON SC
29456-3912
US

V. Phone/Fax

Practice location:
  • Phone: 843-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number24513
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number24513
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number24513
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number24513
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: