Provider Demographics
NPI:1639312630
Name:EDWARDS, TONYA L (OTR)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 PRIORITY WAY W DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240
Mailing Address - Country:US
Mailing Address - Phone:317-805-4963
Mailing Address - Fax:317-818-0720
Practice Address - Street 1:9190 PRIORITY WAY W DR
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240
Practice Address - Country:US
Practice Address - Phone:317-805-4963
Practice Address - Fax:317-818-0720
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002545A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist