Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2699 | SC |
NPI | 1013349760 |
---|---|
Provider Name | Isabelle Witzel |
First Address | Fort Mill, SC 29715-6941 |
Second Address | Fort Mill, SC 29715-6941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2013 |
Last Update Date | 05/08/2013 |