Provider Demographics
NPI:1972362416
Name:KORENEK, CARRIE RENEE
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:RENEE
Last Name:KORENEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:RENEE
Other - Last Name:KORENEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CARRIE KORENEK
Mailing Address - Street 1:280 BRAZOS BND
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77879-1127
Mailing Address - Country:US
Mailing Address - Phone:361-404-9810
Mailing Address - Fax:
Practice Address - Street 1:280 BRAZOS BND
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TX
Practice Address - Zip Code:77879-1127
Practice Address - Country:US
Practice Address - Phone:361-404-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008733225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist