Provider Demographics
NPI:1629273438
Name:PORCH, CAROLYN BARNETT (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:BARNETT
Last Name:PORCH
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 1:342 RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-1704
Mailing Address - Country:US
Mailing Address - Phone:325-338-1123
Mailing Address - Fax:
Practice Address - Street 1:1504 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5438
Practice Address - Country:US
Practice Address - Phone:325-338-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist