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General NPI Number Information
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NPI Number | 1265733125
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Entity Type | Individual
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Provider Name | JASON KUPIEC
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Gender | Male
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | TRUST SERVICES 5253 MULHOLLAND DRIVE
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City | SUMMERVILLE
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State | SC
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Zip | 29485
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Country | US
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Telephone | 843-879-8892
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Fax |
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Provider Business Mailing Address
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Address Line | 5253 MULHOLLAND DR
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8077
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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 |
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 24513
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 24513
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 24513
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | 24513
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License Number State | SC
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