Provider Demographics
NPI:1427632504
Name:VANZANT, VIRGINIA DODD (OTR/L)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DODD
Last Name:VANZANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 BERRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29832-2660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:269 BERRY FARM RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:SC
Practice Address - Zip Code:29832-2660
Practice Address - Country:US
Practice Address - Phone:803-257-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1543225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology