Provider Demographics
NPI:1356086581
Name:ROANE, KAREN MICHELLE (COMS)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MICHELLE
Last Name:ROANE
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38635
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1135
Mailing Address - Country:US
Mailing Address - Phone:804-404-5236
Mailing Address - Fax:
Practice Address - Street 1:3513 BRIEL ST UNIT 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6855
Practice Address - Country:US
Practice Address - Phone:804-404-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226912255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind