Provider Demographics
NPI:1124136049
Name:MCTAVISH, JOANNE (OT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:MCTAVISH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LONG POINT RD
Mailing Address - Street 2:SUITE #270
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7930
Mailing Address - Country:US
Mailing Address - Phone:843-884-4783
Mailing Address - Fax:
Practice Address - Street 1:570 LONG POINT RD
Practice Address - Street 2:SUITE 270
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7930
Practice Address - Country:US
Practice Address - Phone:843-884-4783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1641225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist