Healthcare Provider Details

I. General information

NPI: 1043144256
Provider Name (Legal Business Name): HANNAH ALICE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 PINEHAVEN STREET EXT
LAURENS SC
29360-2672
US

IV. Provider business mailing address

1499 BUSH RIVER RD
CLINTON SC
29325-6705
US

V. Phone/Fax

Practice location:
  • Phone: 864-984-6584
  • Fax:
Mailing address:
  • Phone: 864-923-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5664
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: