Provider Demographics
NPI:1679788756
Name:EDWARDS, JAMES M (COTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9256 HAYES ST
Mailing Address - Street 2:APT 201
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6582
Mailing Address - Country:US
Mailing Address - Phone:219-736-2930
Mailing Address - Fax:
Practice Address - Street 1:3405 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-2363
Practice Address - Country:US
Practice Address - Phone:219-462-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001284A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant