Provider Demographics
NPI:1952473670
Name:VANWYKE, JANE D
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:D
Last Name:VANWYKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 BEE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6702
Mailing Address - Country:US
Mailing Address - Phone:803-788-6195
Mailing Address - Fax:
Practice Address - Street 1:9600 TWO NOTCH RD
Practice Address - Street 2:SUITE 24
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4304
Practice Address - Country:US
Practice Address - Phone:803-736-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC620225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist