Provider Demographics
NPI:1093856049
Name:WAHN, KAREN LEIGH (COTA L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:WAHN
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 1:142 WESTVIEW PL
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1254
Mailing Address - Country:US
Mailing Address - Phone:618-407-2127
Mailing Address - Fax:
Practice Address - Street 1:142 WESTVIEW PL
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1254
Practice Address - Country:US
Practice Address - Phone:618-407-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant