Provider Demographics
NPI:1396942702
Name:TATE, KARI A (THERAPY TECH)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:A
Last Name:TATE
Suffix:
Gender:F
Credentials:THERAPY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1661
Mailing Address - Country:US
Mailing Address - Phone:317-745-7419
Mailing Address - Fax:
Practice Address - Street 1:255 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1415
Practice Address - Country:US
Practice Address - Phone:317-745-5451
Practice Address - Fax:317-745-2215
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31010503097247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other