Provider Demographics
NPI:1184688814
Name:FOGLE, KAREN S (OTR-L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:FOGLE
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:S
Other - Last Name:FASICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:31 S DORCAS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2110
Mailing Address - Country:US
Mailing Address - Phone:717-248-6261
Mailing Address - Fax:717-248-6264
Practice Address - Street 1:31 S DORCAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2110
Practice Address - Country:US
Practice Address - Phone:717-248-6261
Practice Address - Fax:717-248-6264
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005615L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001927518Medicaid
PA075131Medicare ID - Type UnspecifiedMEDICARE #