Provider Demographics
NPI:1124442728
Name:SWEATT, MELANNIE
Entity type:Individual
Prefix:
First Name:MELANNIE
Middle Name:
Last Name:SWEATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 WILDEWOOD DOWNS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223
Mailing Address - Country:US
Mailing Address - Phone:803-419-0431
Mailing Address - Fax:
Practice Address - Street 1:1215 WILDEWOOD DOWNS CIRCLE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-419-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9006224Z00000X
SC2931224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant