Provider Demographics
NPI:1609452192
Name:ENDOW, CHARISSA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:
Last Name:ENDOW
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 1:2001 WILSHIRE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5683
Mailing Address - Country:US
Mailing Address - Phone:310-829-3320
Mailing Address - Fax:
Practice Address - Street 1:2001 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5683
Practice Address - Country:US
Practice Address - Phone:310-829-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22145225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA449539OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
CA22145OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY