Healthcare Provider Details

I. General information

NPI: 1194651448
Provider Name (Legal Business Name): TERESA LYNN MARINACCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 JOHNNIE DODDS BLVD STE G
MOUNT PLEASANT SC
29464-3100
US

IV. Provider business mailing address

14 OLD FORT DR
HILTON HEAD ISLAND SC
29926-2698
US

V. Phone/Fax

Practice location:
  • Phone: 843-654-9694
  • Fax:
Mailing address:
  • Phone: 914-263-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8033
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: