Provider Demographics
NPI:1952428039
Name:MARSHALL, KAREN RAE
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RAE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:EDWARDS
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:106 SHADY LANE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-678-0168
Mailing Address - Fax:606-485-4563
Practice Address - Street 1:106 SHADY LANE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-678-0168
Practice Address - Fax:606-485-4563
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYN-A174400000X
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist