Marissa Fullard

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

7409 Issued in SC

Practice address

297 W Boyce St
Manning, SC 29102-3004

Phone

(803) 433-9001

NPI assigned

Oct 25, 2024

Last updated

Oct 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Lakes Therapy LLC

  • Physical Therapist
  • Manning, SC
  • NPI 1700212420

  Occupational Therapist

  Medicare reassignment NPD
• Rehabcare Group East, LLC

  dba RehabCare

  • Rehabilitation Clinic/Center
  • Hilton Head, SC
  • NPI 1114443728
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1124840798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 AIRPORT RD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291538784",
            "telephone_number": "770-519-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 W BOYCE ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023004",
            "telephone_number": "803-433-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLARD",
        "first_name": "MARISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "7409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Ashleigh Evans, PA
• Faith Therapeutic Services
• Ashlee Finnell, OD
• Jordan Carter Floyd
• Judy Lynn Fry, CNM
• Ryan Tyler Fullen, OD
• Gamble Dentalsmart PC (DentalSmart)
• Tracy Ganes, CRNA
• Reynald Bassig Garma, MD
• Marion Claire Geddings, FNP-BC

• Occupational Therapist in Manning, SC
• Providers in Manning, SC by specialty
• Occupational Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.