MEDICARE: PLUFF MUD CHILDREN'S THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1356282099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUFF MUD CHILDREN'S THERAPY

Provider Business Mailing Address
First Line	:	1849 CAPRI DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7603
Country	:	US
Telephone Number	:	843-564-3119
Fax Number	:	833-452-0726

Provider Business Practice Location Address
First Line	:	1849 CAPRI DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7603
Country	:	US
Telephone Number	:	843-564-3119
Fax Number	:	833-452-0726

Authorized Official
Title or Position	:	OWNER
Name	:	DENVER MERRILL
Credential	:
Telephone Number	:	843-564-3119

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “PLUFF MUD CHILDREN'S THERAPY ” Practice Location

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