Basic Information
| Provider Information | |||||||||
| NPI: | 1376731901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EISERT | ||||||||
| FirstName: | BETTY KATHRYN | ||||||||
| MiddleName: | NEAL | ||||||||
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| Credential: | MSR, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 ASHLEY AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294253500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437923481 | ||||||||
| FaxNumber: | 8437923075 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 ASHLEY AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294253500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437923481 | ||||||||
| FaxNumber: | 8437923075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 3325 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.