Provider Demographics
NPI:1851437016
Name:KOETZLE, KAREN G
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:G
Last Name:KOETZLE
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 1:3865 BEECH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3652
Mailing Address - Country:US
Mailing Address - Phone:513-561-2237
Mailing Address - Fax:
Practice Address - Street 1:3865 BEECH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3652
Practice Address - Country:US
Practice Address - Phone:513-561-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-4037225X00000X
KYKY-R2136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist