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NPI Code Detail

MEDICARE: JILL GRIMES

MEDICARE: JILL GRIMES
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
1224Z00000XOccupational Therapy Assistant1118SC

General Provider Information

NPI Number : 1265795116
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL GRIMES
Provider Business Mailing Address
First Line : 1226 HARVESTER CIR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-3292
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1226 HARVESTER CIR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-3292
Country : US
Telephone Number : 336-465-6527
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2012
Last Update Date : 06/15/2012

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Directions to “ JILL GRIMES ” Practice Location

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