Basic Information
Provider Information
NPI: 1215134754
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PLYLER
FirstName: MICHELE
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: COTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2134 WOODMORE CIR
Address2:  
City: FLORENCE
State: SC
PostalCode: 295056848
CountryCode: US
TelephoneNumber: 8436657990
FaxNumber:  
Practice Location
Address1: 555 E CHEVES ST
Address2:  
City: FLORENCE
State: SC
PostalCode: 295062617
CountryCode: US
TelephoneNumber: 8437776700
FaxNumber: 8437772051
Other Information
ProviderEnumerationDate: 06/28/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
224Z00000X1720SCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant 

No ID Information.


Home