Provider Demographics
NPI:1932781283
Name:EDWARDS, DEREK CHRISTOPHER (OTD/ OTR/L)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:CHRISTOPHER
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:OTD/ OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43148-9534
Mailing Address - Country:US
Mailing Address - Phone:740-215-9023
Mailing Address - Fax:
Practice Address - Street 1:300 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1708
Practice Address - Country:US
Practice Address - Phone:740-385-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT10842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist