Provider Demographics
NPI:1841251618
Name:PETTENGILL, KAREN M (MS, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:PETTENGILL
Suffix:
Gender:F
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RAINGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1208
Mailing Address - Country:US
Mailing Address - Phone:413-772-0939
Mailing Address - Fax:
Practice Address - Street 1:3550 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1089
Practice Address - Country:US
Practice Address - Phone:413-733-3939
Practice Address - Fax:413-733-7062
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist