Healthcare Provider Details

I. General information

NPI: 1457712861
Provider Name (Legal Business Name): KAREN MICHELLE MITCHELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10127 MOROCCO ST STE 202
SAN ANTONIO TX
78216-3938
US

IV. Provider business mailing address

PO BOX 591622
SAN ANTONIO TX
78259-0130
US

V. Phone/Fax

Practice location:
  • Phone: 210-838-5351
  • Fax:
Mailing address:
  • Phone: 618-722-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056011444
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2016004728
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number117992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: