Provider Demographics
NPI:1023371523
Name:SHEALYTHERAPEUTICS
Entity Type:Organization
Organization Name:SHEALYTHERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SHEALY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, OTR
Authorized Official - Phone:864-923-5339
Mailing Address - Street 1:2432 OLD DOUGLASS RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-7799
Mailing Address - Country:US
Mailing Address - Phone:864-923-5339
Mailing Address - Fax:185-527-1460
Practice Address - Street 1:2432 OLD DOUGLASS RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-7799
Practice Address - Country:US
Practice Address - Phone:864-923-5339
Practice Address - Fax:185-527-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty