Provider Demographics
NPI:1811932262
Name:CAWTHON, KAREN RENEE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:CAWTHON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:RENEE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5401 FORDHAM DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4623
Mailing Address - Country:US
Mailing Address - Phone:505-293-1019
Mailing Address - Fax:
Practice Address - Street 1:1600 40TH ST NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7708
Practice Address - Country:US
Practice Address - Phone:505-891-5335
Practice Address - Fax:505-891-1178
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer