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General NPI Number Information
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NPI Number | 1639290448
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Entity Type | Individual
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Provider Name | STEPHANEY SMITH-ROSE
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 930 S RON MCNAIR BLVD STE B
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City | LAKE CITY
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State | SC
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Zip | 29560-3831
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Country | US
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Telephone | 843-210-3082
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Fax | 843-210-3051
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Provider Business Mailing Address
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Address Line | 900 S IRBY ST # 501
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City | FLORENCE
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State | SC
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Zip | 29501-5239
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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 | 824
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License Number State | SC
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