Provider Demographics
NPI:1467424366
Name:BARRETT, CAROLYN C (LOT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:C
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 INTERSTATE 35 N
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-1136
Mailing Address - Country:US
Mailing Address - Phone:254-235-7604
Mailing Address - Fax:254-235-7612
Practice Address - Street 1:6610 INTERSTATE 35 N
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-1136
Practice Address - Country:US
Practice Address - Phone:254-235-7604
Practice Address - Fax:254-235-7612
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108724174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177929001Medicaid