Provider Demographics
NPI:1275618704
Name:VISSER, CHARITY ANN (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:ANN
Last Name:VISSER
Suffix:
Gender:F
Credentials:MS,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:P.O. BOX 90902
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-0902
Mailing Address - Country:US
Mailing Address - Phone:907-980-1679
Mailing Address - Fax:
Practice Address - Street 1:203 W 15TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5128
Practice Address - Country:US
Practice Address - Phone:907-980-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1753225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT1753Medicaid
AK1023562Medicaid