MEDICARE: SORINITY SUPPORT SERVICES LLC

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	224Z00000X	Occupational Therapy Assistant

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	:	1407113723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SORINITY SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	4000 FABER PLACE DR STE 300
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-8587
Country	:	US
Telephone Number	:	866-273-6377
Fax Number	:	866-364-7607

Provider Business Practice Location Address
First Line	:	4000 FABER PLACE DR STE 300
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-8587
Country	:	US
Telephone Number	:	866-273-6377
Fax Number	:	866-364-7607

Authorized Official
Title or Position	:	OWNER
Name	:	ALVINA ROBERTS
Credential	:
Telephone Number	:	866-273-6377

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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Directions to “SORINITY SUPPORT SERVICES LLC ” Practice Location

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