Provider Demographics
NPI:1992260442
Name:BYRUM, CHARITY ANNE (OT)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:ANNE
Last Name:BYRUM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 CANA RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-6126
Mailing Address - Country:US
Mailing Address - Phone:336-940-2088
Mailing Address - Fax:336-450-4499
Practice Address - Street 1:307 UPTON ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1735
Practice Address - Country:US
Practice Address - Phone:336-940-2088
Practice Address - Fax:336-450-4499
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11296225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist