Provider Demographics
NPI:1376882902
Name:CAIN, CAROLYN A (COMS)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:A
Last Name:CAIN
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 C AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-7145
Mailing Address - Country:US
Mailing Address - Phone:893-727-3347
Mailing Address - Fax:
Practice Address - Street 1:514 C AVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7145
Practice Address - Country:US
Practice Address - Phone:893-727-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5657225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5657OtherACVREP