Provider Demographics
NPI:1740409564
Name:MONACO, KAREN G (OTR)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:G
Last Name:MONACO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W SPRING GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3739
Mailing Address - Country:US
Mailing Address - Phone:803-279-0616
Mailing Address - Fax:706-262-5502
Practice Address - Street 1:1225 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2141
Practice Address - Country:US
Practice Address - Phone:706-650-5501
Practice Address - Fax:706-262-5502
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000512225X00000X
SC458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00862496AMedicaid
SCTH0031Medicaid
SCTH0031Medicaid