MEDICARE: MRS. HEATHER M VICK 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	5536	NC
2	225X00000X	Occupational Therapist	2422	SC

General Provider Information

NPI Number	:	1447402292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER M VICK OTR/L

Provider Business Mailing Address
First Line	:	1571 SANFORD RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6952
Country	:	US
Telephone Number	:	704-241-3432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1571 SANFORD RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6952
Country	:	US
Telephone Number	:	704-241-3432
Fax Number	:

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	11/18/2014

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