Provider Demographics
NPI:1619285020
Name:PHILIPP, MARIE M (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:PHILIPP
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:908 PYATT ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2820
Mailing Address - Country:US
Mailing Address - Phone:843-240-3903
Mailing Address - Fax:
Practice Address - Street 1:407 CHURCH ST
Practice Address - Street 2:SUITE E
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3792
Practice Address - Country:US
Practice Address - Phone:843-545-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist