Provider Demographics
NPI:1427193481
Name:CAROLINA THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CAROLINA THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:GADDY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:843-385-6162
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-0736
Mailing Address - Country:US
Mailing Address - Phone:843-385-6162
Mailing Address - Fax:866-800-5103
Practice Address - Street 1:5341 HIGHWAY 17
Practice Address - Street 2:SUITE F
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5074
Practice Address - Country:US
Practice Address - Phone:843-385-6162
Practice Address - Fax:866-800-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4727Medicaid