Provider Demographics
NPI:1891396073
Name:THELE, CAROLYN ROSE GARCIA
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ROSE GARCIA
Last Name:THELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 931
Mailing Address - Street 2:
Mailing Address - City:BARRACKVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26559-0931
Mailing Address - Country:US
Mailing Address - Phone:304-534-0239
Mailing Address - Fax:
Practice Address - Street 1:698 RICE STREET
Practice Address - Street 2:APARTMENT 7
Practice Address - City:BARRACKVILLE
Practice Address - State:WV
Practice Address - Zip Code:26559
Practice Address - Country:US
Practice Address - Phone:304-534-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant