Provider Demographics
NPI:1154645794
Name:EMERY, CHARLOTTE E (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:E
Last Name:EMERY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4125
Mailing Address - Country:US
Mailing Address - Phone:207-653-4934
Mailing Address - Fax:
Practice Address - Street 1:25 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4125
Practice Address - Country:US
Practice Address - Phone:207-653-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT517225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME202540000Medicaid