Healthcare Provider Details

I. General information

NPI: 1255588158
Provider Name (Legal Business Name): KAREN BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12145 STATE HIGHWAY 14 N TRLR L2 L-2
CEDAR CREST NM
87008-9504
US

IV. Provider business mailing address

12145 STATE HIGHWAY 14 N TRLR L2 L-2
CEDAR CREST NM
87008-9504
US

V. Phone/Fax

Practice location:
  • Phone: 239-464-2817
  • Fax:
Mailing address:
  • Phone: 239-464-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3172
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: