Healthcare Provider Details

I. General information

NPI: 1245702760
Provider Name (Legal Business Name): KAREN DOUBLE BARNES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1896
US

IV. Provider business mailing address

6615 ENGLISH OAK DR
EAST LANSING MI
48823-9617
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5464
  • Fax:
Mailing address:
  • Phone: 517-290-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5201002562
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201002562
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: