Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2920 | SC |
NPI | 1013282748 |
---|---|
Provider Name | Marian Spina |
First Address | Beaufort, SC 29902-2845 |
Second Address | Beaufort, SC 29902-5441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2012 |
Last Update Date | 13/03/2012 |