MEDICARE: KAREN MICHELLE PARKS OT

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	225XP0200X	Pediatric Occupational Therapist	OT001375	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932284403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MICHELLE PARKS OT

Provider Business Mailing Address
First Line	:	4212 CORAL PARK DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-3016
Country	:	US
Telephone Number	:	912-996-2069
Fax Number	:	912-265-0041

Provider Business Practice Location Address
First Line	:	4212 CORAL PARK DR STE E
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-3016
Country	:	US
Telephone Number	:	912-996-2069
Fax Number	:	912-265-0041

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/19/2019

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