Healthcare Provider Details

I. General information

NPI: 1730581059
Provider Name (Legal Business Name): LAUREL KARR P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 17TH AVE
VERO BEACH FL
32960-3641
US

IV. Provider business mailing address

5050 FAIRWAYS CIR APT 305
VERO BEACH FL
32967-7450
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-6877
  • Fax:
Mailing address:
  • Phone: 772-532-4276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberPTA24277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: