Individual
TIFFANY NICOLE EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
155 WOODLAND RD, MARIETTA, SC 29661-9734
(864) 483-0387
Mailing address
155 WOODLAND RD, MARIETTA, SC 29661-9734
(864) 483-0387
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
10033
NC
224Z00000X
Occupational Therapy Assistant
3510
SC
224Z00000X
Occupational Therapy Assistant
Primary
TA2852
MS
Other
Enumeration date
01/22/2016
Last updated
01/22/2016
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