Provider Demographics
NPI:1891414645
Name:TRILLHAASE, KARLY
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:TRILLHAASE
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 1:20 FARM LN
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2351
Mailing Address - Country:US
Mailing Address - Phone:732-832-5386
Mailing Address - Fax:
Practice Address - Street 1:20 FARM LN
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2351
Practice Address - Country:US
Practice Address - Phone:732-832-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer