Provider Demographics
NPI:1376941609
Name:VALENTINE, CHARLENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:VALENTINE
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 1:800 FALLS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7665
Mailing Address - Country:US
Mailing Address - Phone:817-888-2973
Mailing Address - Fax:
Practice Address - Street 1:5801 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4209
Practice Address - Country:US
Practice Address - Phone:817-346-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11497225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist