Individual
TERESA MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1026 RADIUS ST, MANNING, SC 29102-7836
(843) 598-9306
Mailing address
1026 RADIUS ST, MANNING, SC 29102-7836
(843) 598-9306
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
886
SC
225X00000X
Occupational Therapist
4582
SC
Other
Enumeration date
04/02/2007
Last updated
09/10/2015
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