Provider Demographics
NPI:1801495833
Name:FAIRCHILD, KAREN MARIE CODD (MPS, LCAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE CODD
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MPS, LCAT, ATR-BC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:CODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPS, LCAT, ATR-BC
Mailing Address - Street 1:364 S 1ST ST APT 20
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4725
Mailing Address - Country:US
Mailing Address - Phone:917-256-9665
Mailing Address - Fax:
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2897
Practice Address - Country:US
Practice Address - Phone:718-206-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001953221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist