Provider Demographics
NPI:1538666474
Name:EDWARDS, TOBY REED (OTA)
Entity Type:Individual
Prefix:MR
First Name:TOBY
Middle Name:REED
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E DEBBIE LN APT 1406
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4132
Mailing Address - Country:US
Mailing Address - Phone:806-402-0284
Mailing Address - Fax:
Practice Address - Street 1:850 12TH AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2516
Practice Address - Country:US
Practice Address - Phone:817-882-8289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206163224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant