Provider Demographics
NPI:1083787378
Name:FULKERSON, KAREN LYNN (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNN
Last Name:FULKERSON
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946
Mailing Address - Country:US
Mailing Address - Phone:618-253-7210
Mailing Address - Fax:
Practice Address - Street 1:2907 WILLIAMSON COUNTY PARKWAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-998-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant