Basic Information
| Provider Information | |||||||||
| NPI: | 1427030535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEAGIN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTRL, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777120 | ||||||||
| FaxNumber: | 8437777102 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 JOHNS ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436625233 | ||||||||
| FaxNumber: | 8436789003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 11/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 1552 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 5247260001 | 01 | SC | MEDICARE DME | OTHER | TH1387 | 05 | SC | MEDICAID |