MEDICARE: ELITE HAND AND UPPER EXTREMITY THERAPY

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	225XH1200X	Hand Occupational Therapist

General Provider Information

NPI Number	:	1467086926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HAND AND UPPER EXTREMITY THERAPY

Provider Business Mailing Address
First Line	:	1314 WATERWAY DR
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2538
Country	:	US
Telephone Number	:	304-676-2077
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 2ND AVE N STE 6
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3200
Country	:	US
Telephone Number	:	304-676-2077
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	DANIEL A BURKHART
Credential	:	MS, OTR/L
Telephone Number	:	304-676-2077

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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