Provider Demographics
NPI:1154657567
Name:CHADDOCK, KAREN LEIGH (OTR)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:CHADDOCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LEIGH
Other - Last Name:WARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3205 HURLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3853
Mailing Address - Country:US
Mailing Address - Phone:916-485-6711
Mailing Address - Fax:916-485-2653
Practice Address - Street 1:3205 HURLEY WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3853
Practice Address - Country:US
Practice Address - Phone:916-485-6711
Practice Address - Fax:916-485-2653
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1546225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics