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General NPI Number Information
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NPI Number | 1235773227
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Entity Type | Organization
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Legal Business Name | LIFE CENTERED MOBILITY, LLC
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 12/15/2019
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Provider Practice Location Address
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Address Line | 552 OLD IRON WORKS RD
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City | SPARTANBURG
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State | SC
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Zip | 29302-4431
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Country | US
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Telephone | 803-504-3540
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8252
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City | GREENVILLE
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State | SC
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Zip | 29604-8252
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Country | US
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Telephone | 864-365-6116
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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 | CANDANCE TUTWILER CODE
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Credential | OTD, OTR/L
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Telephone | 662-719-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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