Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | SC |
NPI | 1013417377 |
---|---|
Provider Name | Mary Talbert Slaven |
First Address | Columbia, SC 29201-3520 |
Second Address | Columbia, SC 29201-3520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 13/02/2018 |