Provider Demographics
NPI:1144074980
Name:EDWARDS, SABRINA BROUGHTON (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:BROUGHTON
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:SABRINA
Other - Middle Name:NICOLE
Other - Last Name:BROUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1800 KILLIAN LAKES DR APT 10301
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8867
Mailing Address - Country:US
Mailing Address - Phone:843-534-7202
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist