Provider Demographics
NPI:1942345152
Name:WASSON, CHARLES ANDREW (OTR)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ANDREW
Last Name:WASSON
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 1:2412 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3637
Mailing Address - Country:US
Mailing Address - Phone:410-456-6045
Mailing Address - Fax:
Practice Address - Street 1:631 WASHINGTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2214
Practice Address - Country:US
Practice Address - Phone:410-986-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist