Provider Demographics
NPI:1841607884
Name:CLAUSEN, KARLYE (ATC)
Entity Type:Individual
Prefix:
First Name:KARLYE
Middle Name:
Last Name:CLAUSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KARLYE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2747 PARK PLACE LN APT 13
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-5235
Mailing Address - Country:US
Mailing Address - Phone:715-577-3065
Mailing Address - Fax:
Practice Address - Street 1:700 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-5595
Practice Address - Country:US
Practice Address - Phone:715-577-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2452-392255A2300X
MN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty