Provider Demographics
NPI:1225637739
Name:CARPENTER, MOLLY WHITWORTH (OTR)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:WHITWORTH
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 N LAKE DR APT 1223
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8117
Mailing Address - Country:US
Mailing Address - Phone:704-308-1232
Mailing Address - Fax:
Practice Address - Street 1:720 OLD CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9406
Practice Address - Country:US
Practice Address - Phone:803-490-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist