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General NPI Number Information
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NPI Number | 1497387583
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Entity Type | Individual
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Provider Name | FABIOLA SORIA
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Gender | Female
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 113 E MAIN ST STE A
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City | LEXINGTON
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State | SC
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Zip | 29072-3449
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Country | US
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Telephone | 803-704-4759
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Fax |
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Provider Business Mailing Address
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Address Line | 16842 STATE HIGHWAY 215 S # 112
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City | WINNSBORO
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State | SC
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Zip | 29180-7355
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Country | US
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Telephone | 210-385-7923
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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 | 6518
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 120547
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License Number State | TX
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