Provider Demographics
NPI:1124711486
Name:MCPHERSON, CHARLES EDWARD
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 OLD SEVEN RD
Mailing Address - Street 2:
Mailing Address - City:COOLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45723-9778
Mailing Address - Country:US
Mailing Address - Phone:740-236-3908
Mailing Address - Fax:
Practice Address - Street 1:2200 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1300
Practice Address - Country:US
Practice Address - Phone:304-428-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1336224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant