Provider Demographics
NPI:1841499852
Name:WITTY, KAREN S (DI/IECE/MAE)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:S
Last Name:WITTY
Suffix:
Gender:F
Credentials:DI/IECE/MAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CORAL HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9080
Mailing Address - Country:US
Mailing Address - Phone:270-404-5981
Mailing Address - Fax:270-651-2966
Practice Address - Street 1:235 CORAL HILL RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-9080
Practice Address - Country:US
Practice Address - Phone:270-404-5981
Practice Address - Fax:270-651-2966
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist