Provider Demographics
NPI:1619494069
Name:MICHAEL, KARA (OTR)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6895 GLEN WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4110
Mailing Address - Country:US
Mailing Address - Phone:409-363-0653
Mailing Address - Fax:
Practice Address - Street 1:6895 GLEN WILLOW DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4110
Practice Address - Country:US
Practice Address - Phone:409-363-0653
Practice Address - Fax:409-363-0653
Is Sole Proprietor?:No
Enumeration Date:2017-08-26
Last Update Date:2017-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XF0002X, 225XP0200X
TX115877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics