Individual
TYWANNA SHARDAE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
83 THOMSON CIR, ABBEVILLE, SC 29620-5652
(864) 366-5122
Mailing address
104 OAKLAND AVE APT 1401, ABBEVILLE, SC 29620-2723
(864) 447-7111
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5347
SC
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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