Provider Demographics
NPI:1225102122
Name:THOM, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:THOM
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 1:1313 CAMPBELL RD
Mailing Address - Street 2:B-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6458
Mailing Address - Country:US
Mailing Address - Phone:713-468-0300
Mailing Address - Fax:713-468-0336
Practice Address - Street 1:13150 FM 529 RD
Practice Address - Street 2:SUITE 114
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-2570
Practice Address - Country:US
Practice Address - Phone:713-896-1815
Practice Address - Fax:713-896-1853
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist