Individual
REGINALD LASALLE HARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
117 BELLFIELD RD, RIDGEWAY, SC 29130-8261
(803) 337-2257
(803) 337-2255
Mailing address
205 WOODHAVEN RD, COLUMBIA, SC 29203-9289
(803) 840-3808
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2412
SC
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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