Provider Demographics
NPI:1013310416
Name:MAKHENZON, SERGEI (OT)
Entity Type:Individual
Prefix:MR
First Name:SERGEI
Middle Name:
Last Name:MAKHENZON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 ROSE WALK CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8511
Mailing Address - Country:US
Mailing Address - Phone:843-513-4139
Mailing Address - Fax:
Practice Address - Street 1:1469 APPLING DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4688
Practice Address - Country:US
Practice Address - Phone:843-225-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist