MEDICARE: CAROLINA CHILDREN'S THERAPY LLC

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	1334	SC

General Provider Information

NPI Number	:	1922315027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CHILDREN'S THERAPY LLC

Provider Business Mailing Address
First Line	:	2060 NORTHBROOK BLVD, SUITE 103
Second Line	:	CAROLINA CHILDREN'S THERAPY LLC
City	:	N. CHARLESTON
State	:	SC
Zip	:	29406-9811
Country	:	US
Telephone Number	:	843-572-2450
Fax Number	:	843-572-2451

Provider Business Practice Location Address
First Line	:	2060 NORTHBROOK BLVD, SUITE 103
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9811
Country	:	US
Telephone Number	:	843-572-2450
Fax Number	:	843-572-2451

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. NESSIE P SCHROM
Credential	:	OTR/L, BCP
Telephone Number	:	843-572-2450

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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