Basic Information
| Provider Information | |||||||||
| NPI: | 1417024167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCHALE | ||||||||
| FirstName: | KELI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 WHISPERING GLEN CIR | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291702764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037399311 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2705 LEAPHART RD | ||||||||
| Address2: | AGAPE THERAPY | ||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039265119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 612 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.