MEDICARE: MRS. CHARLOTTE ANNE ANDERSON OTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	Z20579	LA

General Provider Information

NPI Number	:	1679846273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE ANNE ANDERSON OTA

Provider Business Mailing Address
First Line	:	2238 WINDSOR CT
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5442
Country	:	US
Telephone Number	:	318-272-0693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2238 WINDSOR CT
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5442
Country	:	US
Telephone Number	:	318-272-0693
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	02/14/2012

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