Provider Demographics
NPI:1427463603
Name:PERKINS, MARY LELL
Entity type:Individual
Prefix:MS
First Name:MARY LELL
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:700 WOODROW ST
Mailing Address - Street 2:APT #406
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1757
Mailing Address - Country:US
Mailing Address - Phone:803-318-4151
Mailing Address - Fax:
Practice Address - Street 1:700 WOODROW ST
Practice Address - Street 2:APT #406
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1757
Practice Address - Country:US
Practice Address - Phone:803-318-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist