Healthcare Provider Details

I. General information

NPI: 1336738814
Provider Name (Legal Business Name): ZACHERY C EDWARDS OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GREEN END AVE
MIDDLETOWN RI
02842-5620
US

IV. Provider business mailing address

333 GREEN END AVE
MIDDLETOWN RI
02842-5620
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-7100
  • Fax:
Mailing address:
  • Phone: 401-849-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT02476
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: