Healthcare Provider Details

I. General information

NPI: 1609709294
Provider Name (Legal Business Name): CHARLES GOSSETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MOUNTAIN COVE DR STE B
OWENS CROSS ROADS AL
35763-7211
US

IV. Provider business mailing address

42465 HIGHWAY 195
HALEYVILLE AL
35565-7052
US

V. Phone/Fax

Practice location:
  • Phone: 256-704-4261
  • Fax: 256-704-0080
Mailing address:
  • Phone: 256-350-1764
  • Fax: 256-355-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6982
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: