Provider Demographics
NPI:1780891184
Name:CARPENTER, KAREN ANN (OTR)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 N HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8401
Mailing Address - Country:US
Mailing Address - Phone:810-653-3666
Mailing Address - Fax:
Practice Address - Street 1:G 4466 W. BRISTOL ROAD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-342-5381
Practice Address - Fax:810-342-5362
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist