Provider Demographics
NPI:1124246004
Name:BANKS, KARLI (OTRL)
Entity type:Individual
Prefix:MS
First Name:KARLI
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12310 W ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4145
Mailing Address - Country:US
Mailing Address - Phone:602-403-9423
Mailing Address - Fax:623-266-2827
Practice Address - Street 1:455 N 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-3924
Practice Address - Country:US
Practice Address - Phone:602-528-3450
Practice Address - Fax:602-528-3439
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3311171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3311OtherOCCUPATIONAL THERAPIST