Provider Demographics
NPI:1619729605
Name:KOROBELLIS, KAREN LYNN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:KOROBELLIS
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 1:2 ROSS WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5569
Mailing Address - Country:US
Mailing Address - Phone:856-912-5924
Mailing Address - Fax:
Practice Address - Street 1:2 ROSS WAY
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-5569
Practice Address - Country:US
Practice Address - Phone:856-912-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00204500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist