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General NPI Number Information
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NPI Number | 1144675901
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY THERAPEUTIC
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 1622 WRECKLERS RACE LN
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City | CHARLESTON
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State | SC
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Zip | 29414-7920
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Country | US
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Telephone | 616-970-0709
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 WRECKLERS RACE LN
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City | CHARLESTON
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State | SC
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Zip | 29414-7920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | KATELYN MARY BEUKER
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Credential | OTR/L
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Telephone | 616-970-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 4291
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License Number State | SC
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