Provider Demographics
NPI:1477119030
Name:THOMPSON, CAREY R (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CAREY
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COUNTY ROAD 2917
Mailing Address - Street 2:
Mailing Address - City:DODD CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75438-3202
Mailing Address - Country:US
Mailing Address - Phone:972-849-1356
Mailing Address - Fax:
Practice Address - Street 1:1001 COUNTY ROAD 2917
Practice Address - Street 2:
Practice Address - City:DODD CITY
Practice Address - State:TX
Practice Address - Zip Code:75438-3202
Practice Address - Country:US
Practice Address - Phone:972-849-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209101224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant