Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XH1200X | Occupational Therapist - Hand | 997225 | OR |
Y | 225XH1200X | Occupational Therapist - Hand | OT00002353 | WA |
NPI | 1255315735 |
---|---|
Provider Name | Amy Charlton |
First Address | Vancouver, WA 98664-3299 |
Second Address | Vancouver, WA 98664-3299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 23/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
098565005 | BCBSO (01) | OR |
101860 | WA L&I (01) | WA |
231755 | (05) | OR |
8419871 | (05) | WA |