Provider Demographics
NPI:1427138239
Name:ZUSMAN, KAREN CAGEN (OTR L)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:CAGEN
Last Name:ZUSMAN
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 1:12736 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-7620
Mailing Address - Country:US
Mailing Address - Phone:219-242-4818
Mailing Address - Fax:
Practice Address - Street 1:18308 MURDOCK CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1025
Practice Address - Country:US
Practice Address - Phone:941-764-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000637A225X00000X
FLOT17585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN670001569Medicare ID - Type UnspecifiedRR MEDICARE
IN658990AMedicare ID - Type Unspecified
IN000000087965OtherANTHEM