Provider Demographics
NPI:1437928447
Name:HODGE, DAISY (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 TICKLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4813
Mailing Address - Country:US
Mailing Address - Phone:803-486-0995
Mailing Address - Fax:
Practice Address - Street 1:1012 TICKLE HILL RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4813
Practice Address - Country:US
Practice Address - Phone:803-486-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist