Provider Demographics
NPI:1114740800
Name:EDWARDS, ELIZABETH CLAIRE (OT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CLAIRE
Other - Last Name:SHYRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2336 SPRUCE ST APT F
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4654
Mailing Address - Country:US
Mailing Address - Phone:303-885-0603
Mailing Address - Fax:
Practice Address - Street 1:2336 SPRUCE ST APT F
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4654
Practice Address - Country:US
Practice Address - Phone:303-885-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist