Provider Demographics
NPI:1407084338
Name:KING, TERRIE MAE (OT)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:MAE
Last Name:KING
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:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-7515
Mailing Address - Country:US
Mailing Address - Phone:903-692-3463
Mailing Address - Fax:
Practice Address - Street 1:649 COUNTY ROAD 433
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-6332
Practice Address - Country:US
Practice Address - Phone:903-692-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20345101YP2500X
TX106894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional