Healthcare Provider Details

I. General information

NPI: 1710813845
Provider Name (Legal Business Name): ASHLEY LAUREN KIRK OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 BARONY ST STE 3
MONCKS CORNER SC
29461-3145
US

IV. Provider business mailing address

400 BLACK OAK RD
BONNEAU SC
29431-8722
US

V. Phone/Fax

Practice location:
  • Phone: 843-790-4093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.7979
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: