Provider Demographics
NPI:1407084973
Name:KINCHELOE, THOMAS ANDREW (OTR/L, CLT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANDREW
Last Name:KINCHELOE
Suffix:
Gender:M
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 PRATHER PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7910
Mailing Address - Country:US
Mailing Address - Phone:843-742-5701
Mailing Address - Fax:843-742-5704
Practice Address - Street 1:100 PRATHER PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7910
Practice Address - Country:US
Practice Address - Phone:843-742-5701
Practice Address - Fax:843-742-5704
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist