Active NPI
Stephaney Smith-Rose
- Occupational Therapist
- Lake City, SC
National Provider Identifier
1639290448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 824
- Practice address
- 930 S Ron McNair Blvd Ste B
Lake City, SC 29560-3831 - Phone
- (843) 210-3082
- Fax
- (843) 210-3051
- NPI assigned
- Apr 2, 2007
- 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 | 824 | SC | Primary |
Addresses
Primary practice location
930 S Ron McNair Blvd Ste B
Lake City, SC 29560-3831
Mailing address
900 S Irby St # 501
Florence, SC 29501-5239
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 824 | SC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639290448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 S IRBY ST # 501",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295015239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 S RON MCNAIR BLVD STE B",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295603831",
"telephone_number": "843-210-3082",
"fax_number": "843-210-3051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH-ROSE",
"first_name": "STEPHANEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "824",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.