MEDICARE: MADISYN ALANA KOMAR MOT

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	7315	SC

General Provider Information

NPI Number	:	1811609779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISYN ALANA KOMAR MOT

Provider Business Mailing Address
First Line	:	320 SEAPORT LN UNIT 3112
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-2996
Country	:	US
Telephone Number	:	757-407-6524
Fax Number	:

Provider Business Practice Location Address
First Line	:	1744 SAM RITTENBERG BLVD STE E
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4942
Country	:	US
Telephone Number	:	843-474-2240
Fax Number	:

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

Provider Enumeration Date	:	12/21/2022
Last Update Date	:	03/11/2026

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