Provider Demographics
NPI:1407986276
Name:DODSON, CHARLES W (OTR)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:DODSON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 S HARLAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80123-0897
Mailing Address - Country:US
Mailing Address - Phone:720-283-1103
Mailing Address - Fax:
Practice Address - Street 1:2530 S PARKER RD STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1623
Practice Address - Country:US
Practice Address - Phone:303-306-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
017410OtherKAISER-COMMERCIAL NUMBER