Provider Demographics
NPI:1649694381
Name:PRESCOTT, KAREN (PTA)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:PRESCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:37 GRAY BIRCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-242-3500
Mailing Address - Fax:
Practice Address - Street 1:37 GRAY BIRCH DR
Practice Address - Street 2:AUGUSTA
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6105
Practice Address - Country:US
Practice Address - Phone:207-242-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2416225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant