Individual
EBONI BROOKE COPELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2514 FARAWAY DR, COLUMBIA, SC 29223-3969
(803) 865-1999
Mailing address
PO BOX 211111, COLUMBIA, SC 29221-6111
(803) 466-4017
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
SC
Enumeration date
04/05/2020
Last updated
04/05/2020
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