Individual
KATHRYN MAZINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3851 COMMERCIAL CENTER DR, LADSON, SC 29456-4146
(843) 314-5434
Mailing address
3851 COMMERCIAL CENTER DR, LADSON, SC 29456-4146
(843) 314-5434
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6585
SC
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH5069
—
SC
Enumeration date
01/18/2022
Last updated
10/17/2022
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