Provider Demographics
NPI:1841695277
Name:CANTRELL, KAREN JOELENE (ATC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JOELENE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NOEL DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3938
Mailing Address - Country:US
Mailing Address - Phone:404-333-2096
Mailing Address - Fax:
Practice Address - Street 1:1408 NOEL DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-3938
Practice Address - Country:US
Practice Address - Phone:404-333-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0010442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
110302104OtherNATA BOC CERTIFICATION