Charles Nelson – Occupational Therapist

Key facts

NPI: 1104469766
Entity type: Individual (NPI type 1)
Primary specialty: Occupational Therapist 225X00000X
License: U1-0000254 (DE)
Practice address: 2501 Centerville Rd
Wilmington, DE 19808-1603
Phone: (302) 633-4091
Fax: (302) 633-5680
NPI assigned: Oct 25, 2019
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Gateway Lab School Local Education Agency (LEA) · Wilmington, DE · NPI 1275965832

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
U1-0000254	DE	MD	Occupational Therapist

Practice roles

Organization	Specialty	Status	New patients
Gateway Lab School		Past since Oct 27, 2019	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Occupational Therapist Group: 193400000X SINGLE SPECIALTY GROUP	225X00000X	U1-0000254	DE	Yes

Addresses

Primary practice location

2501 Centerville Rd
Wilmington, DE 19808-1603

Mailing address

8 Jersey CT
Middletown, DE 19709-6813
Phone (302) 449-2085

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 25, 2019.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1104469766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 JERSEY CT",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197096813",
            "telephone_number": "302-449-2085",
            "fax_number": "302-449-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 CENTERVILLE RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198081603",
            "telephone_number": "302-633-4091",
            "fax_number": "302-633-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-25",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "DE",
            "license": "U1-0000254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

All providers in Wilmington, DE · Occupational Therapist in Delaware

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.