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General NPI Number Information
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NPI Number | 1003079534
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Entity Type | Organization
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Legal Business Name | PAUL J. TARDY
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 105 SERENDIPITY WAY # D
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City | LEXINGTON
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State | SC
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Zip | 29072-6999
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Country | US
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Telephone | 803-556-3911
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Fax | 866-887-4617
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Provider Business Mailing Address
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Address Line | 105 SERENDIPITY WAY # D
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City | LEXINGTON
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State | SC
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Zip | 29072-6999
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Country | US
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Telephone | 803-556-3911
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Fax | 866-887-4617
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Authorized Official
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Title or Position | OWNER - OCCUPATIONAL THERAPIST
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Name | MR. PAUL J. TARDY
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Credential | OTR/L
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Telephone | 803-556-3911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3735
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License Number State | SC
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