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General NPI Number Information
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NPI Number | 1053120139
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Entity Type | Individual
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Provider Name | LYDIA GRACE DURANT
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Gender | Female
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 714 S LAKE DR
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City | LEXINGTON
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State | SC
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Zip | 29072-3462
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Country | US
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Telephone | 803-356-4782
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Fax | 803-996-4782
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Provider Business Mailing Address
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Address Line | 181 TOWN CREEK RD
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City | AIKEN
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State | SC
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Zip | 29803-5841
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Country | US
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Telephone | 803-642-0700
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Fax | 803-642-0588
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7446
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License Number State | SC
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