Provider Demographics
NPI:1003079534
Name:PAUL J. TARDY
Entity Type:Organization
Organization Name:PAUL J. TARDY
Other - Org Name:PT THE OT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER - OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TARDY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:803-556-3911
Mailing Address - Street 1:105 SERENDIPITY WAY # D
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6999
Mailing Address - Country:US
Mailing Address - Phone:803-556-3911
Mailing Address - Fax:866-887-4617
Practice Address - Street 1:105 SERENDIPITY WAY # D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6999
Practice Address - Country:US
Practice Address - Phone:803-556-3911
Practice Address - Fax:866-887-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3735225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME099039OtherANTHEM
ME11513654OtherCAQH
MEP00393431OtherRAILROAD MEDICARE
ME266140000Medicaid
MEAA49980OtherHARVARD
ME7052332OtherAETNA
SCTH2387Medicaid
MEP00393431OtherRAILROAD MEDICARE