Provider Demographics
NPI:1033535232
Name:HOLMES, KAREN J (COTA/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:HOLMES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:BORDEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 GREENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2033
Mailing Address - Country:US
Mailing Address - Phone:410-208-1422
Mailing Address - Fax:
Practice Address - Street 1:9715 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3500
Practice Address - Country:US
Practice Address - Phone:410-641-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01726224Z00000X
DEU2-0001100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant