Provider Demographics
NPI:1740443308
Name:LISTON, CHARLOTTE A (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:A
Last Name:LISTON
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 1:214 HARTMAN PL UNIT 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-2465
Mailing Address - Country:US
Mailing Address - Phone:636-629-9826
Mailing Address - Fax:636-629-0359
Practice Address - Street 1:214 HARTMAN PL
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-2464
Practice Address - Country:US
Practice Address - Phone:636-629-9826
Practice Address - Fax:636-629-0359
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004021748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004021748OtherOT LICENSE