Provider Demographics
NPI:1548376643
Name:TRITT, CHARLENE L (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:L
Last Name:TRITT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:CHARLENE
Other - Middle Name:R
Other - Last Name:LOMNETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:5 HILLSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-7374
Mailing Address - Country:US
Mailing Address - Phone:503-638-4040
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR206599225X00000X
WAOT00003918225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist