Provider Demographics
NPI:1164416152
Name:FENNELL, KAREN DENISE (MS, ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DENISE
Last Name:FENNELL
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14825 N OUTER 40 RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:314-336-2566
Mailing Address - Fax:314-336-2639
Practice Address - Street 1:14825 N OUTER 40 RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:314-336-2566
Practice Address - Fax:314-336-2639
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1050222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer