Provider Demographics
NPI:1760773667
Name:LEBEAU, KAREN THERESA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:THERESA
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WARE RD
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-1126
Mailing Address - Country:US
Mailing Address - Phone:860-774-9574
Mailing Address - Fax:860-779-5425
Practice Address - Street 1:150 WARE RD
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-1126
Practice Address - Country:US
Practice Address - Phone:860-774-9574
Practice Address - Fax:860-779-5425
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist