Provider Demographics
NPI:1023209830
Name:ROBERTI, KAREN LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:ROBERTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11477 SE HIGHLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7238
Mailing Address - Country:US
Mailing Address - Phone:503-860-3546
Mailing Address - Fax:
Practice Address - Street 1:15240 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9606
Practice Address - Country:US
Practice Address - Phone:503-860-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13812171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor