Provider Demographics
NPI:1851344477
Name:FAULKENBERRY, EMILY VESTAL (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:VESTAL
Last Name:FAULKENBERRY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WOODGLEN LN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7514
Mailing Address - Country:US
Mailing Address - Phone:803-422-3458
Mailing Address - Fax:
Practice Address - Street 1:112 WOODGLEN LN
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-7514
Practice Address - Country:US
Practice Address - Phone:803-422-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2583225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1377/GP3522Medicaid