MEDICARE: KAREN ANN IVORY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811480734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ANN IVORY

Provider Business Mailing Address
First Line	:	166 HENRY ST APT 2
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-2343
Country	:	US
Telephone Number	:	937-443-0386
Fax Number	:	937-443-0332

Provider Business Practice Location Address
First Line	:	166 HENRY ST APT 2
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-2343
Country	:	US
Telephone Number	:	937-443-0386
Fax Number	:	937-443-0332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/14/2018

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Directions to “ KAREN ANN IVORY ” Practice Location

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