Individual
MISS RAQUEL I CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOT, OTR/L
Contact information
Practice address
64 DANBURY RD, WILTON, CT 06897-4429
(203) 834-3151
(800) 970-5001
Mailing address
64 DANBURY RD, WILTON, CT 06897-4429
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
3764
CT
222Q00000X
Developmental Therapist
5223
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3764
DEPRT. OF PUBLIC HEALTH
CT
01
—
5223
DEPT. OF PUBLIC HEALTH
AZ
Enumeration date
07/23/2009
Last updated
12/27/2012
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