Provider Demographics
NPI:1093886103
Name:BONE, CHARLENE RENAE (COTA)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:RENAE
Last Name:BONE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:CARLENE
Other - Middle Name:RENAE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:301 PARISH PARC DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8908
Mailing Address - Country:US
Mailing Address - Phone:843-532-8575
Mailing Address - Fax:
Practice Address - Street 1:2880 TRICOM ST
Practice Address - Street 2:SIUTE B
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-553-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO783A225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand