Provider Demographics
NPI:1073725800
Name:BLOUNT, KAREN (OTR)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:BLOUNT
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 1:1946 SE STATE ROAD 21
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-5302
Mailing Address - Country:US
Mailing Address - Phone:352-682-4787
Mailing Address - Fax:352-475-3303
Practice Address - Street 1:2027 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609
Practice Address - Country:US
Practice Address - Phone:352-682-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8939174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT8939OtherSTATE LICENSE