Chandler Henshaw Edge, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA002569 Issued in GA

Practice address

402 General Courtney Hodges Boulevard
301
Kathleen, GA 31047

Phone

(478) 213-2927

NPI assigned

Dec 22, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Chandler Marie Henshaw Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beyond Measure Pediatric Therapies, LLC

  • Pediatric Occupational Therapist
  • Perry, GA
  • NPI 1285394957
  NPD (past)

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

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1841950441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 GENERAL COURTNEY HODGES BOULEVARD",
            "address_2": "301",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "31047",
            "telephone_number": "478-213-2927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 GENERAL COURTNEY HODGES BOULEVARD",
            "address_2": "301",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "31047",
            "telephone_number": "478-213-2927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGE",
        "first_name": "CHANDLER",
        "middle_name": "HENSHAW",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "OTA002569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS, UNITED HEALTHCARE, AETNA, TRICARE, CIGNA, HUMANA, SELF-PAY",
            "identifier": "87-405-3673",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHANDLER",
            "last_name": "HENSHAW",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• DME
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• Rebecca Pool Evatt, PHARMD

• All providers in Kathleen, GA
• Occupational Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.