Provider Demographics
NPI:1124469242
Name:ISTRE, CARRIE (COMS, CTVI)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ISTRE
Suffix:
Gender:F
Credentials:COMS, CTVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 TOWN CENTER PL
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3714
Mailing Address - Country:US
Mailing Address - Phone:281-361-9410
Mailing Address - Fax:
Practice Address - Street 1:4439 TOWN CENTER PL
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3714
Practice Address - Country:US
Practice Address - Phone:281-361-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255R0406X, 225CA2400X
1237225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
No2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner