Individual
MR. CHARLES LEWIS SHADLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 533-8252
Mailing address
PO BOX 1035, LULA, GA 30554-1035
(770) 869-0880
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002793
GA
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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