Provider Demographics
NPI:1154353373
Name:HENDERSON, KARYN R (OTR L)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:R
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 EAGLE POINT DR
Mailing Address - Street 2:PO BOX 806
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-5630
Mailing Address - Country:US
Mailing Address - Phone:865-310-3013
Mailing Address - Fax:865-310-3013
Practice Address - Street 1:136 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-5630
Practice Address - Country:US
Practice Address - Phone:865-310-3013
Practice Address - Fax:865-310-3013
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT 2516225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510130Medicaid
TN4215086OtherBLUE CROSS/BLUE SHIELD
TN4004744OtherBLUECROSS BLUESHIELD
TN5440743Medicaid