Provider Demographics
NPI:1932965613
Name:EDWARDS, MARIAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18406 SAND PINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-1666
Mailing Address - Country:US
Mailing Address - Phone:813-481-0273
Mailing Address - Fax:
Practice Address - Street 1:765 W GRANT ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6810
Practice Address - Country:US
Practice Address - Phone:813-743-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT23438225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist