Provider Demographics
NPI:1013239052
Name:REYES, KAREN PASCUA (OT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:PASCUA
Last Name:REYES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:C
Other - Last Name:PASCUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 E VILLAGE GREEN CIR STE C
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5500
Mailing Address - Country:US
Mailing Address - Phone:801-440-5592
Mailing Address - Fax:
Practice Address - Street 1:4557 S WESTERN ST UNIT B4
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-8044
Practice Address - Country:US
Practice Address - Phone:801-440-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist