Individual
CAROLYN BURKE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3620 HAPPY WOODS CT, MYRTLE BEACH, SC 29588-2925
(843) 457-7624
Mailing address
55 REEF RUN RD, PAWLEYS ISLAND, SC 29585-7146
(843) 957-1434
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3651
SC
Other
Enumeration date
07/10/2017
Last updated
07/10/2017
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