Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5148 | SC |
NPI | 1013423748 |
---|---|
Provider Name | Mrs. Kelly Macintire Prater |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29601-2629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2017 |
Last Update Date | 17/10/2021 |