Basic Information
| Provider Information | |||||||||
| NPI: | 1619590825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEAN-CHARLES | ||||||||
| FirstName: | GUERLA | ||||||||
| MiddleName: | ALIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 NEEDLETOP CT | ||||||||
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| City: | MCDONOUGH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302534315 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 W 138TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100371710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126907400 | ||||||||
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| ProviderEnumerationDate: | 05/21/2020 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.