Provider Demographics
NPI:1407307093
Name:WELLS, JO LEIGH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:LEIGH
Last Name:WELLS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JO
Other - Middle Name:LEIGH
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:413 CRIMS CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8877
Mailing Address - Country:US
Mailing Address - Phone:803-210-7506
Mailing Address - Fax:
Practice Address - Street 1:2427 OLD LEXINGTON HWY
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-7917
Practice Address - Country:US
Practice Address - Phone:803-319-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist