Basic Information
| Provider Information | |||||||||
| NPI: | 1629498324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIRKSING | ||||||||
| FirstName: | KARA | ||||||||
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| Credential: | M.ED., OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 BRIDLE PASS WAY | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450501485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133603582 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1879 DEERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450368602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136952900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT- 05937 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.