Healthcare Provider Details

I. General information

NPI: 1154329977
Provider Name (Legal Business Name): KAREN F HARDINE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

410 30TH AVE E SUITE 102
ALEXANDRIA MN
56308-4769
US

IV. Provider business mailing address

410 30TH AVE E SUITE 102
ALEXANDRIA MN
56308-4769
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-5505
  • Fax: 320-763-4447
Mailing address:
  • Phone: 320-763-5505
  • Fax: 320-763-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberAA314567
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: