Healthcare Provider Details

I. General information

NPI: 1205296225
Provider Name (Legal Business Name): KAREN D CALVERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 W PLAZA DR
TALLAHASSEE FL
32308-5325
US

IV. Provider business mailing address

2410 W PLAZA DR
TALLAHASSEE FL
32308-5325
US

V. Phone/Fax

Practice location:
  • Phone: 850-385-6185
  • Fax: 850-385-2580
Mailing address:
  • Phone: 850-385-6185
  • Fax: 850-385-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA14943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: