Provider Demographics
NPI:1124658786
Name:SKILL, CAROLINE MARILYN
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARILYN
Last Name:SKILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 CENTRAL BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8282
Mailing Address - Country:US
Mailing Address - Phone:956-280-5491
Mailing Address - Fax:
Practice Address - Street 1:864 CENTRAL BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8282
Practice Address - Country:US
Practice Address - Phone:956-280-5491
Practice Address - Fax:956-350-9390
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16131261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation