Provider Demographics
NPI:1538117270
Name:CAROLINA HAND THERAPY INC
Entity Type:Organization
Organization Name:CAROLINA HAND THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FIELDS
Authorized Official - Last Name:DE HERDER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L CHT
Authorized Official - Phone:843-766-6494
Mailing Address - Street 1:802 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3183
Mailing Address - Country:US
Mailing Address - Phone:843-856-1634
Mailing Address - Fax:843-856-2534
Practice Address - Street 1:1483 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 205 B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4641
Practice Address - Country:US
Practice Address - Phone:843-766-6494
Practice Address - Fax:843-766-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2871Medicaid
SC6709Medicare PIN