Provider Demographics
NPI:1114381001
Name:MCLEOD, MARCI (ATC)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CAROLA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-4216
Mailing Address - Country:US
Mailing Address - Phone:904-485-0668
Mailing Address - Fax:
Practice Address - Street 1:300 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9422
Practice Address - Country:US
Practice Address - Phone:803-575-5416
Practice Address - Fax:803-575-5420
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer