Provider Demographics
NPI:1538122742
Name:HOSTETTER, KAREN S (ATC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:S
Last Name:HOSTETTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 COLLEGE DR # 5142
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406-0002
Mailing Address - Country:US
Mailing Address - Phone:601-467-1156
Mailing Address - Fax:601-266-4445
Practice Address - Street 1:118 COLLEGE DR # 5142
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0002
Practice Address - Country:US
Practice Address - Phone:601-467-1156
Practice Address - Fax:601-266-4445
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT0468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist