Provider Demographics
NPI:1992569982
Name:BAREFOOT, MARY MADISON (OT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MADISON
Last Name:BAREFOOT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3408
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4015
Mailing Address - Country:US
Mailing Address - Phone:803-732-5887
Mailing Address - Fax:803-732-5997
Practice Address - Street 1:1330 BOILING SPRINGS RD STE 2700
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4215
Practice Address - Country:US
Practice Address - Phone:864-582-0019
Practice Address - Fax:864-582-2160
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist