Provider Demographics
NPI:1366769440
Name:BOGGS, KARLA DIANE (LMT)
Entity type:Individual
Prefix:MS
First Name:KARLA
Middle Name:DIANE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 MANDERLAY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2623
Mailing Address - Country:US
Mailing Address - Phone:859-322-2249
Mailing Address - Fax:
Practice Address - Street 1:1922 WALTON NICHOLSON PIKE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7901
Practice Address - Country:US
Practice Address - Phone:859-363-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3465225700000X
OH33.017830 A-B225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist