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General NPI Number Information
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NPI Number | 1235540097
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Entity Type | Organization
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Legal Business Name | EDEMA THERAPY COMPANY
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 790A DAPHNE AVE
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City | DAPHNE
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State | AL
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Zip | 36526-4657
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Country | US
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Telephone | 251-408-9287
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Fax |
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Provider Business Mailing Address
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Address Line | 790A DAPHNE AVE
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City | DAPHNE
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State | AL
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Zip | 36526-4657
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Country | US
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Telephone | 251-367-5613
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Fax | 800-721-2101
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Authorized Official
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Title or Position | CO OWNER
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Name | JULIE GRANT
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Credential |
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Telephone | 251-978-2754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 11206
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License Number State | FL
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