Provider Demographics
NPI:1356841860
Name:DUTTON, CAROL LYNN (OTR)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:DUTTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19102 JASMINE BLOOM LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4210
Mailing Address - Country:US
Mailing Address - Phone:832-334-3572
Mailing Address - Fax:
Practice Address - Street 1:19102 JASMINE BLOOM LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4210
Practice Address - Country:US
Practice Address - Phone:832-334-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist