Provider Demographics
NPI:1104227552
Name:NELSON, THERESA M (OTR/L)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-5006
Mailing Address - Country:US
Mailing Address - Phone:843-937-6514
Mailing Address - Fax:843-769-2598
Practice Address - Street 1:505A ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5006
Practice Address - Country:US
Practice Address - Phone:843-763-1510
Practice Address - Fax:843-769-2598
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist