Provider Demographics
NPI:1538581368
Name:AXELROD, KAREN (CMT, CST-D)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:AXELROD
Suffix:
Gender:F
Credentials:CMT, CST-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 PALM LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2733
Mailing Address - Country:US
Mailing Address - Phone:310-376-0113
Mailing Address - Fax:310-376-0113
Practice Address - Street 1:510 N PROSPECT AVE STE 208
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3030
Practice Address - Country:US
Practice Address - Phone:310-376-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist