Provider Demographics
NPI:1538975016
Name:CARROLL, KATELYN (OTR, BCP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:OTR, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 LAKE PARK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-2327
Mailing Address - Country:US
Mailing Address - Phone:817-233-8275
Mailing Address - Fax:817-423-7359
Practice Address - Street 1:359 LAKE PARK RD STE 111
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-2327
Practice Address - Country:US
Practice Address - Phone:817-233-8275
Practice Address - Fax:817-423-7359
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124311225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics