Basic Information
| Provider Information | |||||||||
| NPI: | 1720207848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA HAND THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 JOHNNIE DODDS BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294643183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438561634 | ||||||||
| FaxNumber: | 8438562534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1483 TOBIAS GADSON BLVD | ||||||||
| Address2: | SUITE 205B | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294074641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437666494 | ||||||||
| FaxNumber: | 8437666495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | DE HERDER | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | FIELDS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8437666494 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 332B00000X | SC | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | SC | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | DE1955 | 05 | SC | MEDICAID |