Provider Demographics
NPI:1528836095
Name:LEBARON, KAREN SHELBY
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SHELBY
Last Name:LEBARON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4698 W COLANDER DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4919
Mailing Address - Country:US
Mailing Address - Phone:701-580-8134
Mailing Address - Fax:
Practice Address - Street 1:4698 W COLANDER DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4919
Practice Address - Country:US
Practice Address - Phone:701-580-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13673565-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist