Healthcare Provider Details

I. General information

NPI: 1861790354
Provider Name (Legal Business Name): PERRY OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 PARKSIDE DR
NORTH CHARLESTON SC
29405-4103
US

IV. Provider business mailing address

5221 PARKSIDE DR
NORTH CHARLESTON SC
29405-4103
US

V. Phone/Fax

Practice location:
  • Phone: 843-813-6203
  • Fax: 843-212-5839
Mailing address:
  • Phone: 843-813-6203
  • Fax: 843-212-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3529
License Number StateSC

VIII. Authorized Official

Name: CORA TARDIFF
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 843-813-6203