Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 4823 | SC |
NPI | 1063007094 |
---|---|
Provider Name | Winifred Feimster Connolly |
First Address | Edisto, SC 29438-7004 |
Second Address | Edisto, SC 29438-7004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2021 |
Last Update Date | 02/03/2021 |