MEDICARE: KASEY NEELY 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	2919	SC

General Provider Information

NPI Number	:	1295278125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY NEELY OTR/L

Provider Business Mailing Address
First Line	:	450 CHANNEL CREEK CT
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-8120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 CAROL OAKS DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6501
Country	:	US
Telephone Number	:	423-388-5198
Fax Number	:

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

Provider Enumeration Date	:	11/26/2016
Last Update Date	:	11/26/2016

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