Provider Demographics
NPI:1922016054
Name:WYMAN, CAROLINE CROWELL
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:CROWELL
Last Name:WYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:CROWELL
Other - Last Name:WYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTRS
Mailing Address - Street 1:424 COMPASS DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1104
Mailing Address - Country:US
Mailing Address - Phone:650-444-7120
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist