Provider Demographics
NPI:1164653374
Name:SAUNDERS, CHARLES DANA (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DANA
Last Name:SAUNDERS
Suffix:
Gender:M
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 1:23A SOUTHWORTH ST
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-2031
Mailing Address - Country:US
Mailing Address - Phone:203-298-8459
Mailing Address - Fax:
Practice Address - Street 1:915 ELLA T GRASSO BLVD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-5516
Practice Address - Country:US
Practice Address - Phone:203-865-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001104224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant