Provider Demographics
NPI:1447406806
Name:WINGARD, JASON (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:WINGARD
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BONNOITT ST
Mailing Address - Street 2:APARTMENT 7B
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2684
Mailing Address - Country:US
Mailing Address - Phone:843-830-9619
Mailing Address - Fax:
Practice Address - Street 1:2715 S ISLAND RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-4415
Practice Address - Country:US
Practice Address - Phone:843-546-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-16
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist