Provider Demographics
NPI:1609444892
Name:EBERLE, CHARLES IV (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:EBERLE
Suffix:IV
Gender:M
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 1:8500 ATKINS PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3638
Mailing Address - Country:US
Mailing Address - Phone:505-379-2258
Mailing Address - Fax:
Practice Address - Street 1:8500 ATKINS PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3638
Practice Address - Country:US
Practice Address - Phone:505-379-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK163006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist