Provider Demographics
NPI:1851719165
Name:KHAN, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KHAN
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 1:6655 JACKSON ROAD
Mailing Address - Street 2:UNIT 625
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9675
Mailing Address - Country:US
Mailing Address - Phone:734-740-4078
Mailing Address - Fax:
Practice Address - Street 1:6655 JACKSON ROAD
Practice Address - Street 2:UNIT 625
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9675
Practice Address - Country:US
Practice Address - Phone:734-740-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000315225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist