Healthcare Provider Details

I. General information

NPI: 1942940887
Provider Name (Legal Business Name): CAROLYN HALFORD PLETT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN MICHELLE HALFORD OTR

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 LEBANON RD STE 316
FRISCO TX
75036
US

IV. Provider business mailing address

9615 LIVENSHIRE DR
DALLAS TX
75238-2853
US

V. Phone/Fax

Practice location:
  • Phone: 817-479-7019
  • Fax:
Mailing address:
  • Phone: 601-826-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number122503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: