Provider Demographics
NPI:1083812010
Name:GADD, CHARLES RAY (COTAL)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RAY
Last Name:GADD
Suffix:
Gender:M
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7326 ST RTE 19
Mailing Address - Street 2:UNIT 2514
Mailing Address - City:MT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338
Mailing Address - Country:US
Mailing Address - Phone:419-946-1457
Mailing Address - Fax:
Practice Address - Street 1:1750 W 4TH ST
Practice Address - Street 2:MEDCENTRAL HEALTH SYSTEM
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-526-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA01177224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant