Provider Demographics
NPI:1376826958
Name:FARO, CAROL JEANETTE (OT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEANETTE
Last Name:FARO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 RUSH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7222
Mailing Address - Country:US
Mailing Address - Phone:214-726-2211
Mailing Address - Fax:
Practice Address - Street 1:510 N COIT RD STE 2035
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5437
Practice Address - Country:US
Practice Address - Phone:972-437-2048
Practice Address - Fax:972-480-8514
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110645225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110645OtherSTATE LICENSE