Provider Demographics
NPI:1700294196
Name:RICHARDSON, KAREN (CMT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:HYDESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95547-0305
Mailing Address - Country:US
Mailing Address - Phone:707-832-6823
Mailing Address - Fax:
Practice Address - Street 1:1055 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2008
Practice Address - Country:US
Practice Address - Phone:707-832-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist