MEDICARE: CARYE KING WEST OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	225	MT
2	225X00000X	Occupational Therapist	1029015	OR
3	225X00000X	Occupational Therapist	108906	TX
4	225X00000X	Occupational Therapist	642	CO
5	225X00000X	Occupational Therapist	OT2169	ME
6	225X00000X	Occupational Therapist	6839	NC
7	225X00000X	Occupational Therapist	2274	NM

General Provider Information

NPI Number	:	1275861916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARYE KING WEST OT

Provider Business Mailing Address
First Line	:	3005 S LAMAR BLVD
Second Line	:	STE D-109 #225
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-426-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 S LAMAR BLVD
Second Line	:	STE D-109 #225
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-426-1188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	11/18/2009

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