Individual
MS. MAUD N MMBO-KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
148 SAULS ST, STE B, LAKE CITY, SC 29560-2631
(843) 374-0185
(843) 374-0189
Mailing address
405 WAKE ROBIN CT, FLORENCE, SC 29505-3189
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1487
SC
Other
Enumeration date
03/26/2006
Last updated
02/23/2017
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