Marissa Fullard, | |
297 W Boyce St, Manning, SC 29102-3004 | |
(803) 433-9001 | |
Not Available |
Full Name | Marissa Fullard |
---|---|
Gender | Female |
Speciality | Occupational Therapist |
Location | 297 W Boyce St, Manning, South Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1124840798 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225X00000X | Occupational Therapist | 7409 (South Carolina) | Primary |
Provider Name | Southern Lakes Therapy Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1700212420 PECOS PAC ID: 3779711031 Enrollment ID: O20140113000282 |
Mailing Address | Practice Location Address |
---|---|
Marissa Fullard, 1395 Airport Rd, Sumter, SC 29153-8784 Ph: (770) 519-0979 | Marissa Fullard, 297 W Boyce St, Manning, SC 29102-3004 Ph: (803) 433-9001 |
Courtney Sennett, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1051 Blue Heron Pt, Manning, SC 29102 Phone: 570-971-8764 | |
Kristin J Lee, OTR/L Occupational Therapist Medicare: Medicare Enrolled Practice Location: 305 Plantation Dr, Manning, SC 29102 Phone: 434-420-4411 | |
Dr. Charlene G Lenker, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 3147 Sumter Hwy, Manning, SC 29102 Phone: 803-478-2323 | |
Edward Hussey Cornell, OT Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 10 E Hospital St, Manning, SC 29102 Phone: 803-435-3162 Fax: 803-435-3163 | |
Allison Mcgee, MS, OTR/L,CHES Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 50 E Hospital St, Manning, SC 29102 Phone: 803-435-3162 | |
Mrs. Jessica H Yount, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 109 Woodlake Dr, Manning, SC 29102 Phone: 803-478-5440 |