Provider Demographics
NPI:1427456292
Name:OSGOOD, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:OSGOOD
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 1:130 N CANYON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-1149
Mailing Address - Country:US
Mailing Address - Phone:541-953-5507
Mailing Address - Fax:
Practice Address - Street 1:130 N CANYON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1149
Practice Address - Country:US
Practice Address - Phone:541-953-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist