Individual
IRENE ROGERS INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
603 W CAROLINA AVE, HARTSVILLE, SC 29550-4443
(843) 332-3600
(843) 332-1314
Mailing address
PO BOX 1923, HARTSVILLE, SC 29551-1923
(843) 332-3600
(843) 332-1314
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
34
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH0118
—
SC
Enumeration date
05/27/2008
Last updated
05/27/2008
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