Provider Demographics
NPI:1003474214
Name:WOOD, KAREN SUZANNE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUZANNE
Last Name:WOOD
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 1:1630 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-1285
Mailing Address - Country:US
Mailing Address - Phone:740-321-3396
Mailing Address - Fax:740-321-3381
Practice Address - Street 1:1630 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1285
Practice Address - Country:US
Practice Address - Phone:740-321-3396
Practice Address - Fax:740-321-3381
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03368174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist