Healthcare Provider Details

I. General information

NPI: 1598216954
Provider Name (Legal Business Name): KARLY SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 INNSBRUK CT
HOUSTON TX
77066-4307
US

IV. Provider business mailing address

12210 INNSBRUK CT
HOUSTON TX
77066-4307
US

V. Phone/Fax

Practice location:
  • Phone: 361-210-7675
  • Fax:
Mailing address:
  • Phone: 361-210-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: