Active NPI
Maud N Mmbo-Keith, OTR/L
- Occupational Therapist
- Lake City, SC
National Provider Identifier
1497715148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1487
- Practice address
- 148 Sauls St
Ste B
Lake City, SC 29560-2631 - Phone
- (843) 374-0185
- Fax
- (843) 374-0189
- NPI assigned
- Mar 26, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 1487 | SC | Primary |
Addresses
Primary practice location
148 Sauls St
Ste B
Lake City, SC 29560-2631
Mailing address
405 Wake Robin CT
Florence, SC 29505-3189
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1487 | SC | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ih3 Physcial Therapy | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapy Clinic/Center
- Lake City, SC
- NPI 1104145697
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487808000000",
"number": "1497715148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 WAKE ROBIN CT",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295053189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "148 SAULS ST",
"address_2": "STE B",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295602631",
"telephone_number": "843-374-0185",
"fax_number": "843-374-0189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MMBO-KEITH",
"first_name": "MAUD",
"middle_name": "N",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-26",
"last_updated": "2017-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "1487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.