Basic Information
| Provider Information | |||||||||
| NPI: | 1487309373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCARBROUGH | ||||||||
| FirstName: | SAVANNAH | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4778 BREAK HEART RD | ||||||||
| Address2: | |||||||||
| City: | CROZET | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229322011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343056521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 WELLMORE DR | ||||||||
| Address2: | |||||||||
| City: | TEGA CAY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297080124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038357000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2022 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 6427 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.