Provider Demographics
NPI:1649000159
Name:BACCUS, CHARLOTTE E
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:E
Last Name:BACCUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6749
Mailing Address - Country:US
Mailing Address - Phone:754-301-1907
Mailing Address - Fax:
Practice Address - Street 1:1007 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6749
Practice Address - Country:US
Practice Address - Phone:754-301-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81891225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist