Healthcare Provider Details

I. General information

NPI: 1871428078
Provider Name (Legal Business Name): AVERY KALBAS TORDOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 W MARTINTOWN RD
NORTH AUGUSTA SC
29860-7616
US

IV. Provider business mailing address

121 THOMAS DR
MARTINEZ GA
30907-1594
US

V. Phone/Fax

Practice location:
  • Phone: 803-617-7523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7985
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: