Provider Demographics
NPI:1073642864
Name:ANGSTADT, KARIE LYNN (OTRL)
Entity Type:Individual
Prefix:
First Name:KARIE
Middle Name:LYNN
Last Name:ANGSTADT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KARIE
Other - Middle Name:LYNN
Other - Last Name:SHONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:6 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1664
Mailing Address - Country:US
Mailing Address - Phone:877-407-3422
Mailing Address - Fax:877-407-4329
Practice Address - Street 1:801 KINGS HWY N
Practice Address - Street 2:FOX REHABILITATION
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1513
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTR001005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073449PCVMedicare ID - Type UnspecifiedPROVIDER NUMBER