Individual
KRISTEN LEIGH ELLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
100 JOSEPH WALKER DR, WEST COLUMBIA, SC 29169
(803) 936-0310
Mailing address
3104 HEYWARD ST, COLUMBIA, SC 29205
(803) 917-3602
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1869
SC
Other
Enumeration date
04/28/2009
Last updated
04/28/2009
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