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NPI Code Detail

MEDICARE: KAREN LEE TEGNER MANSETH OTR

MEDICARE: KAREN LEE TEGNER MANSETH OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist562CO

General Provider Information

NPI Number : 1144521667
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN LEE TEGNER MANSETH OTR
Provider Business Mailing Address
First Line : 4433 TIERRA ALTA DR
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80104-7676
Country : US
Telephone Number : 404-434-7167
Fax Number :
Provider Business Practice Location Address
First Line : 9085 RANCH RIVER CIR
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80126-5094
Country : US
Telephone Number : 404-434-7167
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2010
Last Update Date : 11/15/2010

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