Provider Demographics
NPI:1770780991
Name:ASIMAKOPOULOS, SARAH MARIE (MS,OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:ASIMAKOPOULOS
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:GOODELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:101 BARLEY ST
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-9619
Mailing Address - Country:US
Mailing Address - Phone:207-944-8013
Mailing Address - Fax:843-553-6828
Practice Address - Street 1:101 BARLEY ST
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-9619
Practice Address - Country:US
Practice Address - Phone:207-944-8013
Practice Address - Fax:843-553-6828
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3319225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1983Medicaid