Healthcare Provider Details

I. General information

NPI: 1184349284
Provider Name (Legal Business Name): ADAPTED LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 DUTCHMAN DR
MOUNT PLEASANT SC
29466-6036
US

IV. Provider business mailing address

2645 DUTCHMAN DR
MOUNT PLEASANT SC
29466-6036
US

V. Phone/Fax

Practice location:
  • Phone: 843-310-4271
  • Fax:
Mailing address:
  • Phone: 843-310-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH BAGLEY
Title or Position: MANAGER
Credential: OTR/L
Phone: 404-932-4754