Basic Information
| Provider Information | |||||||||
| NPI: | 1316453293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLESTON HAND THERAPY CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1483 TOBIAS GADSON BLVD STE 205B | ||||||||
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| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294074641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437666494 | ||||||||
| FaxNumber: | 8437666495 | ||||||||
| Practice Location | |||||||||
| Address1: | 8950 UNIVERSITY BLVD | ||||||||
| Address2: | SUITE 200 ROOM 217 | ||||||||
| City: | N CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437666494 | ||||||||
| FaxNumber: | 8437666495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2017 | ||||||||
| LastUpdateDate: | 01/10/2018 | ||||||||
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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: | MS. | ||||||||
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| AuthorizedOfficialCredential: | OTR L CHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.