Healthcare Provider Details

I. General information

NPI: 1245765825
Provider Name (Legal Business Name): CONNECTIONS PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GATEWAY RD SUITE B
MYRTLE BEACH SC
29579-5400
US

IV. Provider business mailing address

121 GATEWAY RD SUITE B
MYRTLE BEACH SC
29579-5400
US

V. Phone/Fax

Practice location:
  • Phone: 843-503-4102
  • Fax:
Mailing address:
  • Phone: 843-503-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3924
License Number StateSC

VIII. Authorized Official

Name: MRS. LINDSEY PRITCHARD CHAPPELL
Title or Position: DIRECTOR AND OWNER
Credential: OTR/L
Phone: 843-503-4102