Provider Demographics
NPI:1295927598
Name:GRAVENKEMPER, CARLA GUIDRY (OTR)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:GUIDRY
Last Name:GRAVENKEMPER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:GUIDRY
Other - Last Name:GRAVENKEMPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6437 CASTLEMERE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8012
Mailing Address - Country:US
Mailing Address - Phone:972-473-9337
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PKWY STE 225
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1984
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:866-861-4265
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107696225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist