Provider Demographics
NPI:1801082425
Name:BASINGER, NATALIE VALERIE (MCLSCOT)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:VALERIE
Last Name:BASINGER
Suffix:
Gender:F
Credentials:MCLSCOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PLANTATION HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4774
Mailing Address - Country:US
Mailing Address - Phone:843-321-8341
Mailing Address - Fax:843-706-9050
Practice Address - Street 1:71 PLANTATION HOUSE DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-321-8341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3836174400000X, 225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165960721Medicaid
SCOT#3836OtherSOUTH CAROLINA OT BOARD
MD1059568OtherNBCOT
AROTR# 2119OtherAR STATE MEDICAL BOARD