Provider Demographics
NPI:1417130477
Name:CUNNINGHAM, KAREN ANDREA
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANDREA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:ANDREA
Other - Last Name:BORONKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:233 SIERRA VERDE RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7428
Mailing Address - Country:US
Mailing Address - Phone:970-259-5969
Mailing Address - Fax:
Practice Address - Street 1:905 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3104
Practice Address - Country:US
Practice Address - Phone:541-812-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM613174400000X
OR977919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist