Healthcare Provider Details

I. General information

NPI: 1053389577
Provider Name (Legal Business Name): KAREN HAUER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KAREN TANGEN

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIS CMR 470
APO AE
09165
US

IV. Provider business mailing address

BOX 871 CMR 470
APO AE
09165
US

V. Phone/Fax

Practice location:
  • Phone: 314-322-8213
  • Fax: 314-322-8887
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number8153
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: