Provider Demographics
NPI:1821634262
Name:BAZEMORE, KARA DANIELLE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:DANIELLE
Last Name:BAZEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-1685
Mailing Address - Country:US
Mailing Address - Phone:727-287-6300
Mailing Address - Fax:
Practice Address - Street 1:3161 HOWELL MILL RD NW STE 410
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2117
Practice Address - Country:US
Practice Address - Phone:404-351-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist