Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 2416460 | GA |
Y | 225X00000X | Occupational Therapist | 4945 | SC |
N | 225XP0200X | Occupational Therapist - Pediatrics | 4945 | SC |
NPI | 1063836054 |
---|---|
Provider Name | Lauren Douglas |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29601-2629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2014 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | SC |