Provider Demographics
NPI:1295481026
Name:TRAVIS, KAREN MARIE (OTD, MBA, OTR/L)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:OTD, MBA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E COSTILLA ST # 410
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2106
Mailing Address - Country:US
Mailing Address - Phone:619-992-7949
Mailing Address - Fax:
Practice Address - Street 1:945 TENDERFOOT HILL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3920
Practice Address - Country:US
Practice Address - Phone:619-992-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty