Individual provider Active NPI

Charles Nelson

  • Occupational Therapist
  • Wilmington, DE
National Provider Identifier
1104469766
Registry record updated Oct 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
U1-0000254 Issued in DE
Practice address
2501 Centerville Rd
Wilmington, DE 19808-1603
Phone
(302) 633-4091
Fax
(302) 633-5680
NPI assigned
Oct 25, 2019
Last updated
Oct 25, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X U1-0000254 DE Primary

Addresses

Primary practice location

2501 Centerville Rd
Wilmington, DE 19808-1603

Mailing address

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

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
U1-0000254DEMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Lab School PastSince Oct 27, 2019 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.