Provider Demographics
NPI:1922315027
Name:CAROLINA CHILDREN'S THERAPY LLC
Entity Type:Organization
Organization Name:CAROLINA CHILDREN'S THERAPY LLC
Other - Org Name:CAROLINA CHILDRENS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NESSIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHROM
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, BCP
Authorized Official - Phone:843-572-2450
Mailing Address - Street 1:2060 NORTHBROOK BLVD, SUITE 103
Mailing Address - Street 2:CAROLINA CHILDREN'S THERAPY LLC
Mailing Address - City:N. CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9811
Mailing Address - Country:US
Mailing Address - Phone:843-572-2450
Mailing Address - Fax:843-572-2451
Practice Address - Street 1:2060 NORTHBROOK BLVD, SUITE 103
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9811
Practice Address - Country:US
Practice Address - Phone:843-572-2450
Practice Address - Fax:843-572-2451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA CHILDREN'S THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty