Provider Demographics
NPI:1588165732
Name:WADDELL, CHARLEY ELIZABETH MARTIN (OTR)
Entity type:Individual
Prefix:MRS
First Name:CHARLEY
Middle Name:ELIZABETH MARTIN
Last Name:WADDELL
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Gender:F
Credentials:OTR
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Mailing Address - Street 1:300 PELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1182
Mailing Address - Country:US
Mailing Address - Phone:540-484-1456
Mailing Address - Fax:540-484-1236
Practice Address - Street 1:300 PELL AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1182
Practice Address - Country:US
Practice Address - Phone:540-484-1456
Practice Address - Fax:540-484-1236
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2019-12-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist