Individual
JODY LYNN CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
4560 SE INTERNATIONAL WAY, SUITE 100, MILWAUKIE, OR 97222
(971) 206-5129
(971) 206-5209
Mailing address
380 N PROCYON PL, STAR, ID 83669
(208) 286-7235
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT260
ID
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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