=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477887909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN SUE JORDAN OTR/L, C/LT, C/NDT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2009
-----------------------------------------------------
Last Update Date | 10/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 AUTUMN GOLD DR
-----------------------------------------------------
City | GAMBRILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21054-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-306-8892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1004 AUTUMN GOLD DR
-----------------------------------------------------
City | GAMBRILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21054-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-306-8892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0019X
-----------------------------------------------------
Taxonomy Name | Physical Rehabilitation Occupational Therapist
-----------------------------------------------------
License Number | 1374
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------