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General NPI Number Information
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NPI Number | 1790918761
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Entity Type | Individual
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Provider Name | CARRIE CIRO
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Gender | Female
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 4934 CHASE STONE DR
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City | BACLIFF
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State | TX
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Zip | 77518-2508
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Country | US
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Telephone | 405-664-6939
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Fax |
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Provider Business Mailing Address
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Address Line | 4934 CHASE STONE DR
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City | BACLIFF
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State | TX
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Zip | 77518-2508
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Country | US
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Telephone | 405-664-6939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 112369
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License Number State | TX
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