Provider Demographics
NPI:1972606598
Name:LETCHWORTH, CHARLES R (OTR ,CLT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:LETCHWORTH
Suffix:
Gender:M
Credentials:OTR ,CLT
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Mailing Address - Street 1:3409 EDGEMONT TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3650
Mailing Address - Country:US
Mailing Address - Phone:850-339-8145
Mailing Address - Fax:850-597-7062
Practice Address - Street 1:1910 BUFORD BLVD
Practice Address - Street 2:STE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4667
Practice Address - Country:US
Practice Address - Phone:850-339-8145
Practice Address - Fax:850-597-7062
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOT 7931225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9324WMedicare UPIN