Healthcare Provider Details

I. General information

NPI: 1235643669
Provider Name (Legal Business Name): HANNAH MCLAURIN MELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WELLMORE DR
TEGA CAY SC
29708-0124
US

IV. Provider business mailing address

111 WELLMORE DR
TEGA CAY SC
29708-0124
US

V. Phone/Fax

Practice location:
  • Phone: 803-835-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3747
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: