Provider Demographics
NPI:1275861916
Name:WEST, CARYE KING (OT)
Entity Type:Individual
Prefix:
First Name:CARYE
Middle Name:KING
Last Name:WEST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:KING
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:3005 S LAMAR BLVD
Mailing Address - Street 2:STE D-109 #225
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8864
Mailing Address - Country:US
Mailing Address - Phone:512-426-1188
Mailing Address - Fax:
Practice Address - Street 1:3005 S LAMAR BLVD
Practice Address - Street 2:STE D-109 #225
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8864
Practice Address - Country:US
Practice Address - Phone:512-426-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT225225X00000X
OR1029015225X00000X
TX108906225X00000X
CO642225X00000X
MEOT2169225X00000X
NC6839225X00000X
NM2274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist