Provider Demographics
NPI:1164075743
Name:EDWARD, LIYA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LIYA
Middle Name:
Last Name:EDWARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:LIYA
Other - Middle Name:
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:152 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-3101
Mailing Address - Country:US
Mailing Address - Phone:215-796-5240
Mailing Address - Fax:
Practice Address - Street 1:1 SHEPHERDS WAY
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4201
Practice Address - Country:US
Practice Address - Phone:215-956-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist