Healthcare Provider Details

I. General information

NPI: 1205076866
Provider Name (Legal Business Name): IVONETE CAROTHERS B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13802 N HIGHWAY 183
AUSTIN TX
78750-1203
US

IV. Provider business mailing address

8125 JOY RD
LEANDER TX
78641-9651
US

V. Phone/Fax

Practice location:
  • Phone: 512-249-6724
  • Fax:
Mailing address:
  • Phone: 972-342-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: