Provider Demographics
NPI:1194775684
Name:HUTMAKER, MICQUEL W (OTR)
Entity type:Individual
Prefix:
First Name:MICQUEL
Middle Name:W
Last Name:HUTMAKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 WILD OLIVE DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7478
Mailing Address - Country:US
Mailing Address - Phone:843-216-8714
Mailing Address - Fax:843-884-0565
Practice Address - Street 1:601 MATHIS FERRY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2623
Practice Address - Country:US
Practice Address - Phone:843-884-0212
Practice Address - Fax:843-884-0565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2603225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1639Medicaid