Provider Demographics
NPI:1215669619
Name:ISLAND PEDIATRIC THERAPY INC
Entity type:Organization
Organization Name:ISLAND PEDIATRIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:FRAZIER
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:843-270-3412
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:EHRHARDT
Mailing Address - State:SC
Mailing Address - Zip Code:29081-0218
Mailing Address - Country:US
Mailing Address - Phone:843-270-3412
Mailing Address - Fax:843-627-4706
Practice Address - Street 1:1744 SAM RITTENBERG BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4935
Practice Address - Country:US
Practice Address - Phone:843-270-3412
Practice Address - Fax:843-627-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty