Provider Demographics
NPI:1437120268
Name:SCHROM, NESSIE POLLARD (OTRL SIPTA)
Entity Type:Individual
Prefix:MS
First Name:NESSIE
Middle Name:POLLARD
Last Name:SCHROM
Suffix:
Gender:F
Credentials:OTRL SIPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401
Mailing Address - Country:US
Mailing Address - Phone:843-437-1482
Mailing Address - Fax:843-577-5406
Practice Address - Street 1:2060 NORTHBROOK BLVD STE 103
Practice Address - Street 2:CAROLINA CHILDRENS THERAPY DBA
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9811
Practice Address - Country:US
Practice Address - Phone:843-572-2450
Practice Address - Fax:843-572-2451
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1334225X00000X
NC1285225X00000X
SCTH1017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1017Medicaid
980484OtherNATIONAL BOARD