Provider Demographics
NPI:1700417409
Name:COFFMAN, CHARLES DAVID (OTL)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 CUB HILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1127
Mailing Address - Country:US
Mailing Address - Phone:410-887-0174
Mailing Address - Fax:
Practice Address - Street 1:900 S MARLYN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-5843
Practice Address - Country:US
Practice Address - Phone:410-665-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02396225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics