Provider Demographics
NPI:1902380223
Name:CROSS, CHARLEY JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHARLEY
Middle Name:JO
Last Name:CROSS
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 1:919 FERMER RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-7793
Mailing Address - Country:US
Mailing Address - Phone:336-953-8204
Mailing Address - Fax:
Practice Address - Street 1:350 PEE DEE AVE
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4932
Practice Address - Country:US
Practice Address - Phone:866-272-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12105225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist