Provider Demographics
NPI:1164691663
Name:LANGE, KAREN MARIE (BS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:LANGE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9780
Mailing Address - Country:US
Mailing Address - Phone:219-462-9218
Mailing Address - Fax:
Practice Address - Street 1:249 BARBERRY LN
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-9780
Practice Address - Country:US
Practice Address - Phone:219-462-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics