Healthcare Provider Details

I. General information

NPI: 1699742965
Provider Name (Legal Business Name): ERIC B MICHAEL OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 SE MAIN ST STE 200
SIMPSONVILLE SC
29681-3247
US

IV. Provider business mailing address

103 N MAIN ST STE 300
GREENVILLE SC
29601-2796
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-6670
  • Fax:
Mailing address:
  • Phone: 864-528-5700
  • Fax: 864-528-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number580
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: