Provider Demographics
NPI:1306722533
Name:MCDERMOTT, KARLA (LMT)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:MCDERMOTT
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 1:5380 DOVETREE BLVD APT 18
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-5179
Mailing Address - Country:US
Mailing Address - Phone:937-671-6016
Mailing Address - Fax:
Practice Address - Street 1:131 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-2370
Practice Address - Country:US
Practice Address - Phone:937-938-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist