Provider Demographics
NPI:1255622056
Name:LOWCOUNTRY CENTER
Entity type:Organization
Organization Name:LOWCOUNTRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-815-6999
Mailing Address - Street 1:PO BOX 2421
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2421
Mailing Address - Country:US
Mailing Address - Phone:843-815-6999
Mailing Address - Fax:843-815-6998
Practice Address - Street 1:29 PLANTATION PARK DR STE 403
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9006
Practice Address - Country:US
Practice Address - Phone:843-815-6999
Practice Address - Fax:843-815-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3804225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty