Healthcare Provider Details

I. General information

NPI: 1376875153
Provider Name (Legal Business Name): SUSAN MAURINE OLMSCHENK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 HIGHWAY 179
LITTLE RIVER SC
29566-9451
US

IV. Provider business mailing address

393 BLOSSOM TREE LN SE
BOLIVIA NC
28422-8993
US

V. Phone/Fax

Practice location:
  • Phone: 843-279-8613
  • Fax:
Mailing address:
  • Phone: 910-262-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2898
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1419
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: