Active NPI
Alissa Vidovich, OTR/L
- Occupational Therapist
- Myrtle Beach, SC
National Provider Identifier
1972051217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4794
- Practice address
- 101 Brightwater Dr
Myrtle Beach, SC 29579-8275 - Phone
- (843) 236-3579
- NPI assigned
- Sep 15, 2016
- 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 | 4794 | SC | Primary |
Addresses
Primary practice location
101 Brightwater Dr
Myrtle Beach, SC 29579-8275
Mailing address
649 Swinford Dr
Myrtle Beach, SC 29588-4645
Phone (856) 332-3722
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 |
|---|---|---|---|
| 4794 | SC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473897600000",
"number": "1972051217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "649 SWINFORD DR",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295884645",
"telephone_number": "856-332-3722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BRIGHTWATER DR",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295798275",
"telephone_number": "843-236-3579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDOVICH",
"first_name": "ALISSA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-15",
"last_updated": "2016-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "4794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.