Provider Demographics
NPI:1710160569
Name:HILTON HEAD OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:HILTON HEAD OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:843-757-9292
Mailing Address - Street 1:29 PLANTATION PARK DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9001
Mailing Address - Country:US
Mailing Address - Phone:843-757-9292
Mailing Address - Fax:843-757-9294
Practice Address - Street 1:29 PLANTATION PARK DR
Practice Address - Street 2:SUITE 502
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9001
Practice Address - Country:US
Practice Address - Phone:843-757-9292
Practice Address - Fax:843-757-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5962100001OtherMEDICARE DME
SC=========OtherBCBS OF SC
SCQ345120281Medicare PIN
SC=========OtherBCBS OF SC