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NPI Code Detail

MEDICARE: KATHLEEN MAXWELL OTR/L

MEDICARE:   KATHLEEN  MAXWELL  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
1225XP0200XPediatric Occupational Therapist1812SC

General Provider Information

NPI Number : 1205926516
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN MAXWELL OTR/L
Provider Business Mailing Address
First Line : 205 RIVEREDGE DR
Second Line :
City : MOORE
State : SC
Zip : 29369-9019
Country : US
Telephone Number : 864-574-4724
Fax Number :
Provider Business Practice Location Address
First Line : 355 OAK GROVE RD
Second Line :
City : SPARTANBURG
State : SC
Zip : 29301-2537
Country : US
Telephone Number : 864-595-4225
Fax Number : 864-595-4821
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2006
Last Update Date : 07/08/2007

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Directions to “ KATHLEEN MAXWELL OTR/L” Practice Location

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