Healthcare Provider Details

I. General information

NPI: 1114865227
Provider Name (Legal Business Name): FAITH FUCETOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 QUEENSBOROUGH BLVD STE 104
MOUNT PLEASANT SC
29464-5431
US

IV. Provider business mailing address

360 STONEWALL CT APT 4204
MOUNT PLEASANT SC
29464-7990
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-0290
  • Fax:
Mailing address:
  • Phone: 570-369-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7916
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: