Provider Demographics
NPI:1568706919
Name:HENDRICKSON, KAROLEE
Entity Type:Individual
Prefix:MRS
First Name:KAROLEE
Middle Name:
Last Name:HENDRICKSON
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 1:210 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03455-2426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 SNOW RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03470-2806
Practice Address - Country:US
Practice Address - Phone:160-323-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1030225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant