Healthcare Provider Details

I. General information

NPI: 1467506022
Provider Name (Legal Business Name): SHAY F WEED OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 LEAPHART RD STE A
WEST COLUMBIA SC
29169-3068
US

IV. Provider business mailing address

1900 SUNSET BLVD
WEST COLUMBIA SC
29169-5932
US

V. Phone/Fax

Practice location:
  • Phone: 803-454-6090
  • Fax: 803-454-6090
Mailing address:
  • Phone: 803-926-7204
  • Fax: 803-926-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2201
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: