Individual
MARY PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
406 W BROAD ST, IVA, SC 29655-9765
(864) 348-7433
Mailing address
406 W BROAD ST, IVA, SC 29655-9765
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3606
SC
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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