Provider Demographics
NPI:1902011968
Name:LANG, CHARLES THOMAS (OTR)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:THOMAS
Last Name:LANG
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BIRCH LN S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4606
Mailing Address - Country:US
Mailing Address - Phone:701-749-2385
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY S
Practice Address - Street 2:SANFORD HEALTH
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-417-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3837225X00000X
MN103000225X00000X
TX111398225X00000X
AL2485225X00000X
ND1203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist