Provider Demographics
NPI:1114761103
Name:HANVEY, EMMA MACLAINE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MACLAINE
Last Name:HANVEY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BROOKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29696-3031
Mailing Address - Country:US
Mailing Address - Phone:864-784-5106
Mailing Address - Fax:
Practice Address - Street 1:4105 FABER PLACE DR STE 420
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8594
Practice Address - Country:US
Practice Address - Phone:843-894-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7228225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist