Provider Demographics
NPI:1841950441
Name:EDGE, CHANDLER HENSHAW (COTA/L)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:HENSHAW
Last Name:EDGE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CHANDLER
Other - Middle Name:MARIE
Other - Last Name:HENSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 GENERAL COURTNEY HODGES BOULEVARD
Mailing Address - Street 2:301
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047
Mailing Address - Country:US
Mailing Address - Phone:478-213-2927
Mailing Address - Fax:
Practice Address - Street 1:402 GENERAL COURTNEY HODGES BOULEVARD
Practice Address - Street 2:301
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047
Practice Address - Country:US
Practice Address - Phone:478-213-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002569224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA87-405-3673OtherBCBS, UNITED HEALTHCARE, AETNA, TRICARE, CIGNA, HUMANA, SELF-PAY