Provider Demographics
NPI:1760637805
Name:CARLSON, CAROLYN REIDER (OTR, CHT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:REIDER
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 SWEETWATER BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3152
Mailing Address - Country:US
Mailing Address - Phone:281-242-5252
Mailing Address - Fax:281-242-5256
Practice Address - Street 1:4610 SWEETWATER BLVD
Practice Address - Street 2:STE 120
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3152
Practice Address - Country:US
Practice Address - Phone:281-242-5252
Practice Address - Fax:281-242-5256
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105165225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand