Provider Demographics
NPI:1184326662
Name:MANFREDI, CAROLINE ELISE (OTR/L)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELISE
Last Name:MANFREDI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ELISE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 E DAVIS ST APT 2401
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4584
Mailing Address - Country:US
Mailing Address - Phone:225-337-1261
Mailing Address - Fax:
Practice Address - Street 1:2990 LEGACY DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6066
Practice Address - Country:US
Practice Address - Phone:469-888-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist