Provider Demographics
NPI:1316411424
Name:STULTS, KARA MAE (ATC, OTC/L)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MAE
Last Name:STULTS
Suffix:
Gender:F
Credentials:ATC, OTC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 S CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-7823
Mailing Address - Country:US
Mailing Address - Phone:330-618-8615
Mailing Address - Fax:
Practice Address - Street 1:5441 S CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-7823
Practice Address - Country:US
Practice Address - Phone:330-618-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0065342255A2300X
OHOT012989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer