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General NPI Number Information
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NPI Number | 1538688916
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Entity Type | Individual
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Provider Name | MRS. DESTINY FAITH DOUGLAS
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Gender | Female
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Dates
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Enumeration Date | 09/16/2017
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Last Update Date | 09/16/2017
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Provider Practice Location Address
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Address Line | 2091 SAMS ELBOW RD
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City | WEST COLUMBIA
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State | SC
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Zip | 29170-1114
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Country | US
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Telephone | 803-477-7136
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Fax |
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Provider Business Mailing Address
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Address Line | 328 JOSHUA TREE CT
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-7203
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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