MEDICARE: SARAH GASSMAN WILBANKS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1567	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154430668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH GASSMAN WILBANKS OTR/L

Provider Business Mailing Address
First Line	:	9 N BASILICA AVE
Second Line	:
City	:	HANAHAN
State	:	SC
Zip	:	29410-8649
Country	:	US
Telephone Number	:	843-478-4047
Fax Number	:	843-762-7074

Provider Business Practice Location Address
First Line	:	408 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2625
Country	:	US
Telephone Number	:	843-762-3601
Fax Number	:	843-762-7074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/02/2020

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