Provider Demographics
NPI:1336573856
Name:KORZELIUS, KAREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KORZELIUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23123 LAKE TILLERY RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-7625
Mailing Address - Country:US
Mailing Address - Phone:704-796-5493
Mailing Address - Fax:704-986-2472
Practice Address - Street 1:24807 S BUSINESS 52
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8180
Practice Address - Country:US
Practice Address - Phone:704-796-5493
Practice Address - Fax:704-986-2472
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3525225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128 FYOtherBCBS
NC7301373Medicaid