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General NPI Number Information
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NPI Number | 1952014318
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Entity Type | Individual
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Provider Name | SAMUEL JOHN MAYCOCK OTD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 501 FOREST LN STE A
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City | CLEMSON
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State | SC
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Zip | 29631-2621
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Country | US
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Telephone | 864-654-2001
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Fax | 800-305-7112
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Provider Business Mailing Address
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Address Line | PO BOX 616
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City | MARIETTA
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State | SC
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Zip | 29661-0616
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Country | US
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Telephone | 864-214-4431
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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 | 6703
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License Number State | SC
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