Provider Demographics
NPI:1124230016
Name:MORAN, CHARLENE MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:MARIE
Last Name:MORAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 SW BOWMAN COURT
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3316
Mailing Address - Country:US
Mailing Address - Phone:785-273-9979
Mailing Address - Fax:
Practice Address - Street 1:2035 SW BOWMAN COURT
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3316
Practice Address - Country:US
Practice Address - Phone:785-273-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00462224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant