Provider Demographics
NPI:1093824955
Name:MOTT, KAREN GLASOE (RPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GLASOE
Last Name:MOTT
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 DEFENSE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2926
Mailing Address - Country:US
Mailing Address - Phone:410-721-9000
Mailing Address - Fax:410-721-8185
Practice Address - Street 1:2200 DEFENSE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2926
Practice Address - Country:US
Practice Address - Phone:410-721-9000
Practice Address - Fax:410-721-8185
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229967OtherMDIPA/OC/MAMSI/APPO
MD529951OtherAETNA HMO
MD544077-01OtherCAREFIRST BC/BS
MDKY69CROtherCAREFIRST BC/BS
MDR9260003OtherCAREFIRST BC/BS FEP
MD4650653OtherAETNA PPO
MD4650653OtherAETNA PPO