Provider Demographics
NPI:1730302464
Name:STUTLER, KARISA DAWN (MA, OTR)
Entity Type:Individual
Prefix:MS
First Name:KARISA
Middle Name:DAWN
Last Name:STUTLER
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 N COUNTY ROAD 625 E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IN
Mailing Address - Zip Code:47031-9127
Mailing Address - Country:US
Mailing Address - Phone:812-654-4311
Mailing Address - Fax:
Practice Address - Street 1:2313 N COUNTY ROAD 625 E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IN
Practice Address - Zip Code:47031-9127
Practice Address - Country:US
Practice Address - Phone:812-654-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004289A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist