Provider Demographics
NPI:1932648110
Name:WORTHY, VICTORIA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WORTHY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 APPLING DR
Mailing Address - Street 2:APT. 101
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4882
Mailing Address - Country:US
Mailing Address - Phone:478-952-3730
Mailing Address - Fax:
Practice Address - Street 1:1340 APPLING DR
Practice Address - Street 2:APT. 101
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4882
Practice Address - Country:US
Practice Address - Phone:478-952-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4889225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics