Individual
CHARLES E LEMOINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2919 S ELLSWORTH RD, SUITE 111, MESA, AZ 85212-2164
(704) 831-5065
(704) 831-5066
Mailing address
2725 WATER RIDGE PKWY, SUITE 300, CHARLOTTE, NC 28217-4580
(704) 831-5065
(704) 831-5066
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3912
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117502
MEDICARE GROUP PTAN
—
Enumeration date
08/19/2007
Last updated
10/25/2007
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