Provider Demographics
NPI:1669764700
Name:GEORGIA, KARLA (OT)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:GEORGIA
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W WACO DR STE B2
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7013
Mailing Address - Country:US
Mailing Address - Phone:214-901-8623
Mailing Address - Fax:
Practice Address - Street 1:4300 W WACO DR STE B2
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7013
Practice Address - Country:US
Practice Address - Phone:214-901-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109176225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist