Provider Demographics
NPI:1750648838
Name:LAVIGNE, KAREN (LMT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:LAVIGNE
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 1:725 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2559
Mailing Address - Country:US
Mailing Address - Phone:719-846-1639
Mailing Address - Fax:719-846-1524
Practice Address - Street 1:725 SMITH AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2559
Practice Address - Country:US
Practice Address - Phone:719-846-1639
Practice Address - Fax:719-846-1524
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12129225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist