Provider Demographics
NPI:1033476478
Name:WILLIAMS, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 OLD ALICE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8268
Mailing Address - Country:US
Mailing Address - Phone:956-541-2102
Mailing Address - Fax:956-541-2502
Practice Address - Street 1:871 OLD ALICE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8268
Practice Address - Country:US
Practice Address - Phone:956-541-2102
Practice Address - Fax:956-541-2502
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114688OtherSTATE LICENSE