Provider Demographics
NPI:1508009937
Name:ELGIN, AMY NICOLE (MSOL, OTR/L, BCP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:ELGIN
Suffix:
Gender:F
Credentials:MSOL, OTR/L, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 FOLLY RD
Mailing Address - Street 2:STE. B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3938
Mailing Address - Country:US
Mailing Address - Phone:843-314-5434
Mailing Address - Fax:843-277-6237
Practice Address - Street 1:9565 HIGHWAY 78 BLDG 700
Practice Address - Street 2:STE. 102
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4116
Practice Address - Country:US
Practice Address - Phone:843-314-5434
Practice Address - Fax:843-277-6237
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4512225X00000X
PAOC005725L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH2945Medicaid