Provider Demographics
NPI:1497279699
Name:FAIRES, CAREY WILLIAM (LAT)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:WILLIAM
Last Name:FAIRES
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 OLD BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2867
Mailing Address - Country:US
Mailing Address - Phone:830-624-6418
Mailing Address - Fax:
Practice Address - Street 1:558 OLD BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2867
Practice Address - Country:US
Practice Address - Phone:830-624-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT16072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer