Provider Demographics
NPI:1730363672
Name:OCASIO, KARONA (MSPT)
Entity type:Individual
Prefix:
First Name:KARONA
Middle Name:
Last Name:OCASIO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SYCAMORE AVE
Mailing Address - Street 2:APT. #1728
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6710
Mailing Address - Country:US
Mailing Address - Phone:646-295-8041
Mailing Address - Fax:843-793-2400
Practice Address - Street 1:45 SYCAMORE AVE
Practice Address - Street 2:APT. #1728
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6710
Practice Address - Country:US
Practice Address - Phone:646-295-8041
Practice Address - Fax:843-793-2400
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1890Medicaid