Provider Demographics
NPI:1154329977
Name:HARDINE, KAREN F (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:F
Last Name:HARDINE
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 1:410 30TH AVE E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4769
Mailing Address - Country:US
Mailing Address - Phone:320-763-5505
Mailing Address - Fax:320-763-4447
Practice Address - Street 1:410 30TH AVE E
Practice Address - Street 2:SUITE 102
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4769
Practice Address - Country:US
Practice Address - Phone:320-763-5505
Practice Address - Fax:320-763-4447
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-06-11
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MNAA314567225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN520070900Medicaid
MN520070900Medicaid