Healthcare Provider Details

I. General information

NPI: 1134269996
Provider Name (Legal Business Name): KAREN A DENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4154 HIGHWAY 36
SHELBINA MO
63468-4005
US

IV. Provider business mailing address

7004 E HIGHWAY 24
MOBERLY MO
65270-4118
US

V. Phone/Fax

Practice location:
  • Phone: 573-588-4961
  • Fax: 573-588-2490
Mailing address:
  • Phone: 660-263-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004654
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: