Healthcare Provider Details

I. General information

NPI: 1396956546
Provider Name (Legal Business Name): KAREN PORTER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25221 MILES RD SUITE F
CLEVELAND OH
44128-5474
US

IV. Provider business mailing address

25221 MILES RD SUITE F
CLEVELAND OH
44128-5474
US

V. Phone/Fax

Practice location:
  • Phone: 216-514-1600
  • Fax: 216-292-3291
Mailing address:
  • Phone: 216-514-1600
  • Fax: 216-292-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number003552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: