Provider Demographics
NPI:1427411040
Name:HENRY, KAREN ANN (OTR)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 MORNINGSIDE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3528
Mailing Address - Country:US
Mailing Address - Phone:732-539-7735
Mailing Address - Fax:
Practice Address - Street 1:2894 MORNINGSIDE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3528
Practice Address - Country:US
Practice Address - Phone:732-539-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist