Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5355 | SC |
NPI | 1003391293 |
---|---|
Provider Name | Madeline Varn |
First Address | Darlington, SC 29532-2628 |
Second Address | Darlington, SC 29532-2628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2018 |
Last Update Date | 03/10/2018 |