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General NPI Number Information
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NPI Number | 1568382075
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Entity Type | Individual
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Provider Name | KARISSA DETWEILER
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Gender |
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 4890 UNIVERSITY SQ STE 7
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City | HUNTSVILLE
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State | AL
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Zip | 35816-1896
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Country | US
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Telephone | 256-837-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 19224 NE ELIJAH MORRIS RD
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-4324
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 7045
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License Number State | AL
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