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NPI Code Detail

MEDICARE: AVERY PEGUES

MEDICARE: AVERY PEGUES
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
1224Z00000XOccupational Therapy Assistant

General Provider Information

NPI Number : 1578809190
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY PEGUES
Provider Business Mailing Address
First Line : 4401 BELLE OAKS DR
Second Line : SUITE 280
City : NORTH CHARLESTON
State : SC
Zip : 29405-8537
Country : US
Telephone Number : 866-571-2700
Fax Number :
Provider Business Practice Location Address
First Line : 4401 BELLE OAKS DR
Second Line : SUITE 280
City : NORTH CHARLESTON
State : SC
Zip : 29405-8537
Country : US
Telephone Number : 866-571-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2012
Last Update Date : 12/31/2012

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Directions to “ AVERY PEGUES ” Practice Location

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