Provider Demographics
NPI:1386045649
Name:JENKINS, MICHAEL C (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 SADDLEHORN RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-2234
Mailing Address - Country:US
Mailing Address - Phone:843-714-8552
Mailing Address - Fax:
Practice Address - Street 1:1182 SADDLEHORN RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-2234
Practice Address - Country:US
Practice Address - Phone:843-714-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist