MEDICARE: DOROTHY MARIE CHARLES N/A

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1720676257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY MARIE CHARLES N/A

Provider Business Mailing Address
First Line	:	2600 S LOOP W STE 698
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5601
Country	:	US
Telephone Number	:	832-687-8379
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S LOOP W STE 698
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5601
Country	:	US
Telephone Number	:	832-687-8379
Fax Number	:

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

Provider Enumeration Date	:	01/10/2021
Last Update Date	:	01/16/2021

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