Individual
MARK EGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
101 WELLINGTON DR, MOORE, SC 29369-9332
(864) 237-3104
Mailing address
101 WELLINGTON DR, MOORE, SC 29369-9332
(864) 237-3104
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
057004212
IL
224Z00000X
Occupational Therapy Assistant
Primary
3420
SC
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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