Provider Demographics
NPI:1477522811
Name:KAREN KORZELIUS
Entity Type:Organization
Organization Name:KAREN KORZELIUS
Other - Org Name:SENSORY PLAYGROUND OT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PRORPIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KORZELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:704-796-5493
Mailing Address - Street 1:50042 HORSESHOE TRL
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-7628
Mailing Address - Country:US
Mailing Address - Phone:704-986-2472
Mailing Address - Fax:704-986-2472
Practice Address - Street 1:24807 S BUSINESS 52
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8180
Practice Address - Country:US
Practice Address - Phone:704-796-5493
Practice Address - Fax:704-986-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301373Medicaid
128FYOtherBCBS