Provider Demographics
NPI:1124676010
Name:AGS THERAPY
Entity type:Organization
Organization Name:AGS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:843-229-8697
Mailing Address - Street 1:1618 FOX HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-6725
Mailing Address - Country:US
Mailing Address - Phone:843-229-8697
Mailing Address - Fax:
Practice Address - Street 1:1618 FOX HOLLOW CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6725
Practice Address - Country:US
Practice Address - Phone:843-229-8697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty