Provider Demographics
NPI:1710163522
Name:STARR, CAROLYN (OT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 LEARY LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2818
Mailing Address - Country:US
Mailing Address - Phone:361-573-0731
Mailing Address - Fax:361-576-4804
Practice Address - Street 1:1905 LEARY LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2818
Practice Address - Country:US
Practice Address - Phone:361-573-0731
Practice Address - Fax:361-576-4804
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018901225100000X
TX101544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01213010OtherRAILROAD MEDICARE
TX874T15OtherBC/BS #
TX874T15OtherBC/BS PROVIDER #
TX119587701Medicaid
TX119587707Medicaid
P01213010OtherRAILROAD MEDICARE
TXTXB153871Medicare PIN