Provider Demographics
NPI:1780977116
Name:MATTHEWS, CARRIENNE GEORGE (OTD, MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CARRIENNE
Middle Name:GEORGE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:OTD, MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18623 W WINDHAVEN TERRACE TRL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3907
Mailing Address - Country:US
Mailing Address - Phone:504-319-8988
Mailing Address - Fax:
Practice Address - Street 1:18623 W WINDHAVEN TERRACE TRL
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3907
Practice Address - Country:US
Practice Address - Phone:504-319-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116978225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist