Provider Demographics
NPI:1679846273
Name:ANDERSON, CHARLOTTE ANNE (OTA)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5442
Mailing Address - Country:US
Mailing Address - Phone:318-272-0693
Mailing Address - Fax:
Practice Address - Street 1:2238 WINDSOR CT
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5442
Practice Address - Country:US
Practice Address - Phone:318-272-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ20579224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant