Provider Demographics
NPI:1326162249
Name:STORK, KAREN SUE (RN, LMT, CLT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:STORK
Suffix:
Gender:F
Credentials:RN, LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 READING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1009
Mailing Address - Country:US
Mailing Address - Phone:610-736-0800
Mailing Address - Fax:610-736-0456
Practice Address - Street 1:693 READING AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1009
Practice Address - Country:US
Practice Address - Phone:610-736-0800
Practice Address - Fax:610-736-0456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001255225700000X
PARN503089L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse