Provider Demographics
NPI:1073022786
Name:CHARPENTIER, ADRIENNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:CHARPENTIER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SE ELLSWORTH RD APT 59
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-6225
Mailing Address - Country:US
Mailing Address - Phone:360-326-3201
Mailing Address - Fax:
Practice Address - Street 1:1221 SE ELLSWORTH RD APT 59
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-6225
Practice Address - Country:US
Practice Address - Phone:360-326-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00001232224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant