Provider Demographics
NPI:1710651930
Name:RUTHERFORD, KAREN L
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:RUTHERFORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-0092
Mailing Address - Country:US
Mailing Address - Phone:304-823-0223
Mailing Address - Fax:
Practice Address - Street 1:163 WALNUT LN
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:WV
Practice Address - Zip Code:26440-7545
Practice Address - Country:US
Practice Address - Phone:304-823-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV222Q00000X, 252Y00000X
3747P1801X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant