Basic Information
| Provider Information | |||||||||
| NPI: | 1750955035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 SARATOGA TRCE | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400269760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023457279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 S WILLOW ST | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031035714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036819004 | ||||||||
| FaxNumber: | 8889796551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2021 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 31000360A | IN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 133236 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.