Provider Demographics
NPI:1043583305
Name:MOHAIR, CAROLYN MOORE (OT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MOORE
Last Name:MOHAIR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:MAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1713 CASTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-4879
Mailing Address - Country:US
Mailing Address - Phone:940-783-1487
Mailing Address - Fax:
Practice Address - Street 1:5316 TRAIL LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-1931
Practice Address - Country:US
Practice Address - Phone:817-292-8787
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043583305OtherNPI#
TX1043583305OtherNPI#
TX676535Medicare PIN
TX456606Medicare PIN