Provider Demographics
NPI:1295002111
Name:SHAMBAUGH, KAREN K (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:K
Last Name:SHAMBAUGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GLENN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2590
Mailing Address - Country:US
Mailing Address - Phone:301-722-2170
Mailing Address - Fax:301-777-2173
Practice Address - Street 1:217 GLENN ST STE 301
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2590
Practice Address - Country:US
Practice Address - Phone:301-777-2170
Practice Address - Fax:301-777-2173
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06809225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist