Provider Demographics
NPI:1396875548
Name:TABACHECK, DENISE LEIGH
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LEIGH
Last Name:TABACHECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 SHEM CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7161
Mailing Address - Country:US
Mailing Address - Phone:843-294-1222
Mailing Address - Fax:
Practice Address - Street 1:3300 4TH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-6002
Practice Address - Country:US
Practice Address - Phone:843-248-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist