Provider Demographics
NPI:1477120798
Name:HENDERSON, CAROLINE (OTR)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CRIMSON OAK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8181
Mailing Address - Country:US
Mailing Address - Phone:903-249-9011
Mailing Address - Fax:
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-791-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118983OtherTEXAS BOARD OF OCCUPATIONAL THERAPY PRACTITIONERS
397011OtherNATIONAL BOARD OF OCCUPATIONAL THERAPY
SC5965OtherSOUTH CAROLINE BOARD OF OCCUPATIONAL THERAPY