Individual
MRS. MARY K BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
16 JACOBS MILL CT, ELGIN, SC 29045-8646
(803) 419-0427
Mailing address
16 JACOBS MILL CT, ELGIN, SC 29045-8646
(803) 419-0427
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
226
SC
Other
Enumeration date
04/21/2008
Last updated
04/21/2008
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