Provider Demographics
NPI:1740604396
Name:VASIL-BUSCH, KAREN (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:VASIL-BUSCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BACK BRYANT RD
Mailing Address - Street 2:
Mailing Address - City:BUCKFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04220-4109
Mailing Address - Country:US
Mailing Address - Phone:207-336-2065
Mailing Address - Fax:
Practice Address - Street 1:5 DEPOT ST.
Practice Address - Street 2:
Practice Address - City:BUCKFIELD
Practice Address - State:ME
Practice Address - Zip Code:04220
Practice Address - Country:US
Practice Address - Phone:207-336-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0319225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist