Individual
KIMBERLY ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1530 PARKWAY, GREENWOOD, SC 29646-4027
(864) 330-1800
Mailing address
122 DORCHESTER ST, GREENWOOD, SC 29646-9554
(864) 223-0193
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3114
SC
Other
Enumeration date
10/03/2012
Last updated
04/02/2013
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