Provider Demographics
NPI:1831397595
Name:NOURSE, JEANNE (OTR)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:NOURSE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0042
Mailing Address - Country:US
Mailing Address - Phone:864-934-0423
Mailing Address - Fax:864-226-3015
Practice Address - Street 1:1701 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4761
Practice Address - Country:US
Practice Address - Phone:864-934-0423
Practice Address - Fax:864-226-3015
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1023175601OtherINDIVIDUAL