Individual
KAREN DERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6006 BRANDY CHASE CV, FORT WAYNE, IN 46815-7601
(260) 486-3001
Mailing address
3113 STINSON DR, FORT WAYNE, IN 46816-2130
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001472A
IN
Other
Enumeration date
08/25/2008
Last updated
08/25/2008
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