Provider Demographics
NPI:1497019509
Name:BECK, KAREN M (MOT, OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BECK
Suffix:
Gender:F
Credentials:MOT, OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 E 2200 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62531-8336
Mailing Address - Country:US
Mailing Address - Phone:217-827-1713
Mailing Address - Fax:
Practice Address - Street 1:101 E 9TH ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1716
Practice Address - Country:US
Practice Address - Phone:217-562-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009222225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist