Provider Demographics
NPI:1477511897
Name:HARDEE, KATHERINE GRIFFITH (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:GRIFFITH
Last Name:HARDEE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:GRIFFITH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566
Mailing Address - Country:US
Mailing Address - Phone:843-236-9751
Mailing Address - Fax:866-571-1014
Practice Address - Street 1:4761 HWY 501
Practice Address - Street 2:SUITE #1
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-236-9751
Practice Address - Fax:866-571-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1784225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTHO724Medicaid