Provider Demographics
NPI:1376764621
Name:MIRACLE, KAREN EILEEN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:EILEEN
Last Name:MIRACLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:EILEEN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:169 ROBERT MITCHELL RD.
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211
Mailing Address - Country:US
Mailing Address - Phone:270-522-1220
Mailing Address - Fax:
Practice Address - Street 1:169 ROBERT MITCHELL RD
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-8364
Practice Address - Country:US
Practice Address - Phone:270-522-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-RO479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist