Healthcare Provider Details

I. General information

NPI: 1952820094
Provider Name (Legal Business Name): STEPHANIE VICTORIA NASH MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 09/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SUNSET BLVD
WEST COLUMBIA SC
29169-4810
US

IV. Provider business mailing address

128 DRIFTWOOD DR
LEXINGTON SC
29072-9729
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-2000
  • Fax:
Mailing address:
  • Phone: 803-586-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number4928
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: