Provider Demographics
NPI:1932403185
Name:ETHIER, KARLA JEAN (OTR)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:JEAN
Last Name:ETHIER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 LEGACY PKWY E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5469
Mailing Address - Country:US
Mailing Address - Phone:651-777-1641
Mailing Address - Fax:
Practice Address - Street 1:1670 LEGACY PKWY E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5469
Practice Address - Country:US
Practice Address - Phone:651-777-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist