Provider Demographics
NPI:1639290927
Name:DIEROLF, KAREN LYNN (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:DIEROLF
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 ROSS RD.
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-5712
Mailing Address - Country:US
Mailing Address - Phone:210-241-7410
Mailing Address - Fax:
Practice Address - Street 1:7003 WOODWAY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6170
Practice Address - Country:US
Practice Address - Phone:254-776-7864
Practice Address - Fax:254-776-0775
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist