Provider Demographics
NPI:1386901296
Name:WACHENSCHWANZ, CHARLES JOSHUA
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSHUA
Last Name:WACHENSCHWANZ
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 1:10733 STATE ROUTE 682
Mailing Address - Street 2:
Mailing Address - City:THE PLAINS
Mailing Address - State:OH
Mailing Address - Zip Code:45780-1328
Mailing Address - Country:US
Mailing Address - Phone:740-856-6731
Mailing Address - Fax:
Practice Address - Street 1:10733 STATE ROUTE 682
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1328
Practice Address - Country:US
Practice Address - Phone:740-856-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTF824203347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle