MEDICARE: CHRISTY MYJAK OT

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	5507	SC

General Provider Information

NPI Number	:	1649834086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY MYJAK OT

Provider Business Mailing Address
First Line	:	614 WATEREE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6635
Country	:	US
Telephone Number	:	774-721-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 WATEREE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6635
Country	:	US
Telephone Number	:	774-721-6252
Fax Number	:

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

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	04/30/2019

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