Provider Demographics
NPI:1003034331
Name:PROCK, KEL Z GASKIN (MSR, OTR L)
Entity Type:Individual
Prefix:
First Name:KEL Z
Middle Name:GASKIN
Last Name:PROCK
Suffix:
Gender:F
Credentials:MSR, OTR L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:PROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3603 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7713
Mailing Address - Country:US
Mailing Address - Phone:843-424-5450
Mailing Address - Fax:
Practice Address - Street 1:3603 KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7713
Practice Address - Country:US
Practice Address - Phone:843-424-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2713225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics