Bradley Shane Edwards, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

12312 Issued in NC

Practice address

3501 Senior Village LN NW
Wilson, NC 27896-9618

Phone

(252) 243-3186

NPI assigned

Oct 21, 2019

Last updated

Oct 21, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1043853351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "378 SANDHILL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275300906",
            "telephone_number": "252-299-0917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 SENIOR VILLAGE LN NW",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278969618",
            "telephone_number": "252-243-3186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "BRADLEY",
        "middle_name": "SHANE",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-21",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NC",
            "license": "12312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Wilson, NC
• Providers in Wilson, NC by specialty
• Occupational Therapy Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.