Basic Information
| Provider Information | |||||||||
| NPI: | 1124462148 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLESTON HAND THERAPY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1483 TOBIAS GADSON BLVD | ||||||||
| Address2: | SUITE 205B | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294078702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438563200 | ||||||||
| FaxNumber: | 8437666495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1483 TOBIAS GADSON BLVD | ||||||||
| Address2: | SUITE 205B | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294078702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437667694 | ||||||||
| FaxNumber: | 8437666495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2013 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | DE HERDER | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | FIELDS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8437666494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OTR/L CHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.