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General NPI Number Information
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NPI Number | 1295028892
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Entity Type | Individual
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Provider Name | MARY MICHELE PAINE
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Gender | Female
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 100 BLASSINGAME RD
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City | GREENVILLE
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State | SC
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Zip | 29605-3304
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Country | US
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Telephone | 864-452-0017
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Fax |
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Provider Business Mailing Address
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Address Line | 203 KILLARNEY WAY
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City | EASLEY
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State | SC
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Zip | 29642-3125
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 478
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License Number State | SC
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