Healthcare Provider Details

I. General information

NPI: 1043837131
Provider Name (Legal Business Name): KARRA KEITH STEPHENS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 QUILLIAN ST
CLEVELAND GA
30528-1464
US

IV. Provider business mailing address

4617 BROKEN ARROW PATH
GAINESVILLE GA
30506-7514
US

V. Phone/Fax

Practice location:
  • Phone: 706-865-6800
  • Fax:
Mailing address:
  • Phone: 770-539-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT004430
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT004430
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: