Provider Demographics
NPI:1447616800
Name:ASHABRANNER, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ASHABRANNER
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 1:1890 GOODMAN RD E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9504
Mailing Address - Country:US
Mailing Address - Phone:662-269-0420
Mailing Address - Fax:
Practice Address - Street 1:1890 GOODMAN RD E
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9504
Practice Address - Country:US
Practice Address - Phone:662-269-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0732225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist