Provider Demographics
NPI:1316453293
Name:CHARLESTON HAND THERAPY CENTER
Entity type:Organization
Organization Name:CHARLESTON HAND THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FIELDS
Authorized Official - Last Name:DE HERDER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L CHT
Authorized Official - Phone:843-766-6494
Mailing Address - Street 1:1483 TOBIAS GADSON BLVD STE 205B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4641
Mailing Address - Country:US
Mailing Address - Phone:843-766-6494
Mailing Address - Fax:843-766-6495
Practice Address - Street 1:8950 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 200 ROOM 217
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-766-6494
Practice Address - Fax:843-766-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty