=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578907457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLESTON HAND THERAPY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2013
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1483 TOBIAS GADSON BLVD SUITE 205 B
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-8702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-766-6494
-----------------------------------------------------
Fax | 843-766-6495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1483 TOBIAS GADSON BLVD SUITE 205 B
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-8702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-766-6494
-----------------------------------------------------
Fax | 843-766-6495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ELIZABETH FIELDS DE HERDER
-----------------------------------------------------
Credential | OTR/L, CHT
-----------------------------------------------------
Telephone | 843-766-6494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------