Provider Demographics
NPI:1053446039
Name:KITTLE, KAREN SUE (OTR)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:KITTLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 E. 25TH ST.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-5225
Mailing Address - Country:US
Mailing Address - Phone:520-977-5225
Mailing Address - Fax:
Practice Address - Street 1:201 E SOUTHERN AVE
Practice Address - Street 2:#40
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-3740
Practice Address - Country:US
Practice Address - Phone:520-977-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1053446039Medicare NSC