Healthcare Provider Details

I. General information

NPI: 1548089139
Provider Name (Legal Business Name): CHARLESTON HAND THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR RM 2B24
CHARLESTON SC
29414-5741
US

IV. Provider business mailing address

1483 TOBIAS GADSON BLVD STE 205B
CHARLESTON SC
29407-4641
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-6494
  • Fax: 843-766-6495
Mailing address:
  • Phone: 843-766-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH FIELDS DE HERDER
Title or Position: OWNER
Credential: OTR L, CHT
Phone: 843-766-6494