Individual
ERIN M MALTBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3620 COVENANT RD, COLUMBIA, SC 29204-4216
(803) 787-3033
Mailing address
9 NICKLAUS LN, COLUMBIA, SC 29229-3363
(864) 386-8055
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3052
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12659913
CAQH#
—
05
—
TH1620
—
SC
Enumeration date
07/26/2006
Last updated
10/06/2015
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