Provider Demographics
NPI:1376576686
Name:HARLEY, KAREN MICHELLE (OT, CHT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MICHELLE
Last Name:HARLEY
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10219 ADMIRAL HALSEY DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1275
Mailing Address - Country:US
Mailing Address - Phone:505-888-7624
Mailing Address - Fax:
Practice Address - Street 1:1334 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5067
Practice Address - Country:US
Practice Address - Phone:505-292-3317
Practice Address - Fax:505-292-3402
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM208225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00Q672OtherBCBS
NM28970225Medicaid
NM00Q672OtherBCBS