Provider Demographics
NPI:1558960385
Name:GAVLIK, CAREN LUCIA
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:LUCIA
Last Name:GAVLIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 RIVER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-5811
Mailing Address - Country:US
Mailing Address - Phone:361-549-9459
Mailing Address - Fax:
Practice Address - Street 1:2011 E. BROADWAY, STE. 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581
Practice Address - Country:US
Practice Address - Phone:210-888-0368
Practice Address - Fax:888-506-2346
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist