MEDICARE: MONA REBECCA PATTERSON- FOSTER THERAPEUTIC SHOE FIT

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	225000000X	Orthotic Fitter		SC

General Provider Information

NPI Number	:	1609554641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA REBECCA PATTERSON- FOSTER THERAPEUTIC SHOE FIT

Provider Business Mailing Address
First Line	:	9153 TWO NOTCH RD STE C
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5853
Country	:	US
Telephone Number	:	803-394-4421
Fax Number	:

Provider Business Practice Location Address
First Line	:	9153 TWO NOTCH RD STE C
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5853
Country	:	US
Telephone Number	:	803-394-4421
Fax Number	:

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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Directions to “ MONA REBECCA PATTERSON- FOSTER THERAPEUTIC SHOE FIT” Practice Location

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