Individual
MR. PAUL J. TARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
105 SERENDIPITY WAY # D, LEXINGTON, SC 29072-6999
(803) 556-3911
(866) 887-4617
Mailing address
105 SERENDIPITY WAY # D, LEXINGTON, SC 29072-6999
(803) 556-3911
(866) 887-4617
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3735
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099039
ANTHEM
ME
01
—
11513654
CAQH
ME
05
—
266140000
—
ME
01
—
7052332
AETNA
ME
01
—
P00393431
RAILROAD MEDICARE
ME
Enumeration date
02/15/2007
Last updated
06/18/2015
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