Individual
DESIRAE VIOLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
721 WAPPOO RD, CHARLESTON, SC 29407-5861
(843) 402-7850
Mailing address
2915 MARSH BREEZE LN, MOUNT PLEASANT, SC 29466-8696
(860) 917-9178
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5136
SC
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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