Provider Demographics
NPI:1538634712
Name:PRICE, CAROLYN RUTH (OTA)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RUTH
Last Name:PRICE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PALACIOS
Mailing Address - State:TX
Mailing Address - Zip Code:77465-4823
Mailing Address - Country:US
Mailing Address - Phone:979-557-9654
Mailing Address - Fax:
Practice Address - Street 1:405 MOORE AVE
Practice Address - Street 2:
Practice Address - City:PALACIOS
Practice Address - State:TX
Practice Address - Zip Code:77465-4823
Practice Address - Country:US
Practice Address - Phone:979-557-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203835224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant