Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3840 | SC |
NPI | 1003197435 |
---|---|
Provider Name | Susan J Phipps |
First Address | Charlotte, NC 28277-1652 |
Second Address | Rock Hill, SC 29732-8079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2011 |
Last Update Date | 30/08/2011 |