Healthcare Provider Details

I. General information

NPI: 1083714356
Provider Name (Legal Business Name): ANA MARIA ESPANA OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 OAK GROVE ROAD
SPARTANBURG SC
29301
US

IV. Provider business mailing address

180 WOODRIDGE DRIVE
SPARTANBURG SC
29301
US

V. Phone/Fax

Practice location:
  • Phone: 864-595-4225
  • Fax: 864-595-4821
Mailing address:
  • Phone: 864-587-9539
  • Fax: 864-574-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: