Provider Demographics
NPI:1689073298
Name:RINEY, CARI ANN GOODYEAR (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CARI ANN
Middle Name:GOODYEAR
Last Name:RINEY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11751 ALTA VISTA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6442
Mailing Address - Country:US
Mailing Address - Phone:817-562-1006
Mailing Address - Fax:817-562-1009
Practice Address - Street 1:11751 ALTA VISTA RD STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6442
Practice Address - Country:US
Practice Address - Phone:817-562-1006
Practice Address - Fax:817-562-1009
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3559510Medicaid
TX111997OtherTEXAS OCCUPATIONAL THERAPY LICENSE