Provider Demographics
NPI:1659401222
Name:SPRABERRY, CARISSA L (ATC, LAT, MED)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:L
Last Name:SPRABERRY
Suffix:
Gender:F
Credentials:ATC, LAT, MED
Other - Prefix:MISS
Other - First Name:CARISSA
Other - Middle Name:L
Other - Last Name:LOFLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT, MED
Mailing Address - Street 1:20902 NOELLE CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5600
Mailing Address - Country:US
Mailing Address - Phone:832-253-8440
Mailing Address - Fax:
Practice Address - Street 1:8540 C E KING PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-2000
Practice Address - Country:US
Practice Address - Phone:281-727-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT30822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer