Provider Demographics
NPI:1851546253
Name:JORGENSON, KARLA KARRIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:KARRIN
Last Name:JORGENSON
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 1:103 NORTH SPLITROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005
Mailing Address - Country:US
Mailing Address - Phone:605-582-3908
Mailing Address - Fax:605-582-3349
Practice Address - Street 1:103 NORTH SPLITROCK BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005
Practice Address - Country:US
Practice Address - Phone:605-582-3908
Practice Address - Fax:605-582-3349
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0181225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist