Healthcare Provider Details

I. General information

NPI: 1962330993
Provider Name (Legal Business Name): CHARITY GENTRY SOLOMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S MORGAN ST
ROXBORO NC
27573-5245
US

IV. Provider business mailing address

7637 VIRGILINA RD
ROXBORO NC
27574-8391
US

V. Phone/Fax

Practice location:
  • Phone: 336-599-2191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15853
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: