Provider Demographics
NPI:1437366176
Name:HOCKER, KAREN LEE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:HOCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11647HAMLETRD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-9407
Mailing Address - Country:US
Mailing Address - Phone:513-771-2944
Mailing Address - Fax:513-771-2044
Practice Address - Street 1:11647HAMLETRD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-9407
Practice Address - Country:US
Practice Address - Phone:513-771-2944
Practice Address - Fax:513-771-2044
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2172947Medicaid
OH7601894Medicaid