Provider Demographics
NPI:1013628304
Name:EDWARDS, ASHLEY ELISABETH (OTD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELISABETH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELISABETH
Other - Last Name:HALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4105 FABER PLACE DR STE 420
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8594
Mailing Address - Country:US
Mailing Address - Phone:
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:843-792-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOT.7227225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist