Provider Demographics
NPI:1811713340
Name:OSBORN, ADRIENNE LEIGH (LMT, CLT)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LEIGH
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CLT
Mailing Address - Street 1:244 COOPER RUN RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7856
Mailing Address - Country:US
Mailing Address - Phone:843-301-3184
Mailing Address - Fax:
Practice Address - Street 1:2206 MOSSY OAKS RD STE 8
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1046
Practice Address - Country:US
Practice Address - Phone:843-301-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist