Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 46TR00515500 | NJ |
Y | 225X00000X | Occupational Therapist | 46TR00515500 | NJ |
N | 225XH1200X | Occupational Therapist - Hand | 46TR00515500 | NJ |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR00515500 | NJ |
N | 225XR0403X | Driving and Community Mobility | 46TR00515500 | NJ |
NPI | 1689078313 |
---|---|
Provider Name | Mr. Eder Charles |
First Address | Newark, NJ 07108-1219 |
Second Address | Newark, NJ 07108-1219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2014 |
Last Update Date | 09/10/2014 |