Provider Demographics
NPI:1356960090
Name:LYMPHEDEMA WELLNESS, LLC
Entity type:Organization
Organization Name:LYMPHEDEMA WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:MELROY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:843-718-5898
Mailing Address - Street 1:236 CONFEDERATE CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7429
Mailing Address - Country:US
Mailing Address - Phone:843-718-5898
Mailing Address - Fax:
Practice Address - Street 1:236 CONFEDERATE CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7429
Practice Address - Country:US
Practice Address - Phone:843-718-5898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty