Healthcare Provider Details

I. General information

NPI: 1669719530
Provider Name (Legal Business Name): KEY CHANGES THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SUNSET BLVD
WEST COLUMBIA SC
29169-5959
US

IV. Provider business mailing address

1900 SUNSET BLVD
WEST COLUMBIA SC
29169-5959
US

V. Phone/Fax

Practice location:
  • Phone: 803-259-6833
  • Fax: 803-693-0850
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NATALIE MULLIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-250-6833