Provider Demographics
NPI:1770945701
Name:MATTI, KAREN (LMT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MATTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 OLD EKRON RD STE C
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-9360
Mailing Address - Country:US
Mailing Address - Phone:270-422-2442
Mailing Address - Fax:
Practice Address - Street 1:1194 OLD EKRON RD STE C
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-9360
Practice Address - Country:US
Practice Address - Phone:270-422-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4546225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist