Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1872 | SC |
NPI | 1023215753 |
---|---|
Provider Name | Ms. Wendy Ball Free |
First Address | Mt Pleasant, SC 29464-3821 |
Second Address | Mt Pleasant, SC 29464-3821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 08/07/2007 |