Provider Demographics
NPI:1013131762
Name:SNYDER, KAREN M (COTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:SNYDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:LACKIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:115 TILLMAN LN
Mailing Address - Street 2:
Mailing Address - City:BELL BUCKLE
Mailing Address - State:TN
Mailing Address - Zip Code:37020-4039
Mailing Address - Country:US
Mailing Address - Phone:618-795-8225
Mailing Address - Fax:
Practice Address - Street 1:40 N 64TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3808
Practice Address - Country:US
Practice Address - Phone:618-397-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005007868224Z00000X
IL057002697224Z00000X
TN919224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant