Healthcare Provider Details

I. General information

NPI: 1851539787
Provider Name (Legal Business Name): KAREN OSBOURN WAITES MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 CORAL PARK DR
BRUNSWICK GA
31520-3016
US

IV. Provider business mailing address

136 MARSHS EDGE LN
ST SIMONS ISLAND GA
31522-8898
US

V. Phone/Fax

Practice location:
  • Phone: 912-342-8875
  • Fax: 912-342-8016
Mailing address:
  • Phone: 912-634-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT005047
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT005047
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: