Provider Demographics
NPI:1427030535
Name:FEAGIN, BRIAN MARK (OTRL, CHT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MARK
Last Name:FEAGIN
Suffix:
Gender:M
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7120
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:101 JOHNS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2777
Practice Address - Country:US
Practice Address - Phone:843-662-5233
Practice Address - Fax:843-678-9003
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1552225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5247260001OtherMEDICARE DME
SCTH1387Medicaid
SCTH1387Medicaid
SCQ332697938Medicare PIN