Active NPI
Marissa Fullard
- Occupational Therapist
- Manning, SC
National Provider Identifier
1124840798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 7409
- Practice address
- 297 W Boyce St
Manning, SC 29102-3004 - Phone
- (803) 433-9001
- NPI assigned
- Oct 25, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 7409 | SC | Primary |
Addresses
Primary practice location
297 W Boyce St
Manning, SC 29102-3004
Mailing address
1395 Airport Rd
Sumter, SC 29153-8784
Phone (770) 519-0979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Lakes Therapy LLC | Occupational Therapist | Current | Accepting new patients |
| Rehabcare Group East, LLC | Past | Accepting new patients |
Locations
297 W Boyce St
Manning, SC 29102
Phone (803) 433-9001
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Hilton Head Island, SC
- NPI 1114443728
NPI Registry JSON
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": []
}Other providers in Manning, SC
Sources for this page
- 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.