Provider Demographics
NPI:1902118151
Name:WARD, CHARITA DIONNE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:CHARITA
Middle Name:DIONNE
Last Name:WARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HEISMAN WAY
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7104
Mailing Address - Country:US
Mailing Address - Phone:229-224-2380
Mailing Address - Fax:
Practice Address - Street 1:101 COBBLESTONE TRCE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-7747
Practice Address - Country:US
Practice Address - Phone:229-985-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-04
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113682225X00000X
GAOT004480225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist