Provider Demographics
NPI:1245578145
Name:INGRAM, CASEY MARLENE (OTR)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MARLENE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 S MIDLOTHIAN PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5597
Mailing Address - Country:US
Mailing Address - Phone:972-723-0380
Mailing Address - Fax:
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115307225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand