Healthcare Provider Details

I. General information

NPI: 1689641060
Provider Name (Legal Business Name): KATHLEEN MARIE KARELLA OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN MARIE LAMBERT OTR/L

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 KALAKAKET STREET
FAIRBANKS AK
99709
US

IV. Provider business mailing address

PO BOX 70782
FAIRBANKS AK
99707-0782
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-4517
  • Fax:
Mailing address:
  • Phone: 907-488-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number346
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: