Provider Demographics
NPI:1194103267
Name:NOONAN, KAREN MARIE (OT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3168
Mailing Address - Country:US
Mailing Address - Phone:734-474-7479
Mailing Address - Fax:
Practice Address - Street 1:36939 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1162
Practice Address - Country:US
Practice Address - Phone:745-744-8200
Practice Address - Fax:734-902-6082
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist