Provider Demographics
NPI:1861686891
Name:ROELSE, CAROLYN IRENE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:IRENE
Last Name:ROELSE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 HEADWAY CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5160
Mailing Address - Country:US
Mailing Address - Phone:512-478-2581
Mailing Address - Fax:512-476-1638
Practice Address - Street 1:1611 HEADWAY CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5160
Practice Address - Country:US
Practice Address - Phone:512-478-2581
Practice Address - Fax:512-476-1638
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110764225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics