Individual
MIRANDA BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4438 PAMPLICO HWY, FLORENCE, SC 29505-8502
(352) 816-1160
Mailing address
4438 PAMPLICO HWY, FLORENCE, SC 29505-8502
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.5314
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3528161160
CELL NUMBER
—
Enumeration date
09/13/2021
Last updated
09/13/2021
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