=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144074980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABRINA BROUGHTON EDWARDS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2024
-----------------------------------------------------
Last Update Date | 04/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6439 GARNERS FERRY RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29209-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-776-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 KILLIAN LAKES DR APT 10301
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-8867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-534-7202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 6319
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------