Provider Demographics
NPI:1871823062
Name:WRINKLE, KAREN ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:WRINKLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:28737 ARIES ST
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1710
Mailing Address - Country:US
Mailing Address - Phone:818-519-2481
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD STE 560
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1569
Practice Address - Country:US
Practice Address - Phone:818-763-0136
Practice Address - Fax:818-763-3838
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist