Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1346745288 |
---|---|
Provider Name | Elissa Charles |
First Address | Baytown, TX 77520-6113 |
Second Address | Baytown, TX 77520-6113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2018 |
Last Update Date | 23/03/2018 |