Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 691 | SC |
NPI | 1003156175 |
---|---|
Provider Name | Mrs. Mary B. Mims |
First Address | Pamplico, SC 29583-6900 |
Second Address | Pamplico, SC 29583-6900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2013 |
Last Update Date | 01/03/2013 |