Provider Demographics
NPI:1508527656
Name:PILGRIM, CYNTHIA SMITH
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SMITH
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2974 WALHALLA HWY
Mailing Address - Street 2:
Mailing Address - City:SIX MILE
Mailing Address - State:SC
Mailing Address - Zip Code:29682-9522
Mailing Address - Country:US
Mailing Address - Phone:864-419-0007
Mailing Address - Fax:
Practice Address - Street 1:2974 WALHALLA HWY
Practice Address - Street 2:
Practice Address - City:SIX MILE
Practice Address - State:SC
Practice Address - Zip Code:29682-9522
Practice Address - Country:US
Practice Address - Phone:864-419-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2389224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty