MEDICARE: MARTHA CHILDRESS

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	6758	SC

General Provider Information

NPI Number	:	1659052629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA CHILDRESS

Provider Business Mailing Address
First Line	:	PO BOX 170038
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-0020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WILLOW LN
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-1365
Country	:	US
Telephone Number	:	864-641-3125
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	08/22/2023

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Directions to “ MARTHA CHILDRESS ” Practice Location

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