MEDICARE: CHARLESTON CHILDREN'S THERAPY CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225XP0200X	Pediatric Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	2251P0200X	Pediatric Physical Therapist

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	:	1427093749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON CHILDREN'S THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	9225 UNIVERSITY BLVD
Second Line	:	STE. E2C
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9149
Country	:	US
Telephone Number	:	843-569-4546
Fax Number	:	843-569-4535

Provider Business Practice Location Address
First Line	:	9225 UNIVERSITY BLVD
Second Line	:	STE. E2C
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9149
Country	:	US
Telephone Number	:	843-569-4546
Fax Number	:	843-569-4535

Authorized Official
Title or Position	:	CO-OWNER/MANAGER
Name	:	MS. CHARLENE DURHAM
Credential	:	MSR, PT
Telephone Number	:	843-569-4546

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/09/2016

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Directions to “CHARLESTON CHILDREN'S THERAPY CENTER, LLC ” Practice Location

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