Provider Demographics
NPI:1881816312
Name:JONES, CHARLA (OTR)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ARYLE RD
Mailing Address - Street 2:3U
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 ARGYLE RD
Practice Address - Street 2:3U
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5460
Practice Address - Country:US
Practice Address - Phone:718-875-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013167-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist