Active NPI
Cynthia Lynn Clubb-Charles, OTR/L
- Pediatric Occupational Therapist
- Columbia, SC
National Provider Identifier
1891122016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 424
- Practice address
- 430 Wagner TRL
Columbia, SC 29229-7036 - Phone
- (803) 479-7904
- NPI assigned
- Oct 2, 2013
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 424 | SC | Primary |
Addresses
Primary practice location
430 Wagner TRL
Columbia, SC 29229-7036
Mailing address
430 Wagner TRL
Columbia, SC 29229-7036
Phone (803) 479-7904
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 |
|---|---|---|---|
| 424 | SC | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380672000000",
"number": "1891122016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 WAGNER TRL",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292297036",
"telephone_number": "803-479-7904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 WAGNER TRL",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292297036",
"telephone_number": "803-479-7904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLUBB-CHARLES",
"first_name": "CYNTHIA",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-10-02",
"last_updated": "2013-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "SC",
"license": "424",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.