Provider Demographics
NPI:1588052328
Name:ANDERSON, KAREN (PTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W173N10915 BERNIES WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4043
Mailing Address - Country:US
Mailing Address - Phone:262-509-3325
Mailing Address - Fax:
Practice Address - Street 1:W173N10915 BERNIES WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4043
Practice Address - Country:US
Practice Address - Phone:262-509-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1514-19172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker