Provider Demographics
NPI:1497199822
Name:SMALL, KAREN M (PTA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:SMALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 ROCKSIDE RD, SUITE 240
Mailing Address - Street 2:SUPPLEMENTAL HEALTH CARE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44131
Mailing Address - Country:US
Mailing Address - Phone:216-901-0400
Mailing Address - Fax:216-901-0401
Practice Address - Street 1:6500 ROCKSIDE RD, SUITE 240
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44131
Practice Address - Country:US
Practice Address - Phone:216-901-0400
Practice Address - Fax:216-901-0401
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA04853225200000X
OHLMT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist