Provider Demographics
NPI:1154430429
Name:ASELAGE, CAROL A (CO, LO)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:ASELAGE
Suffix:
Gender:F
Credentials:CO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LOUISIANA AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2861
Mailing Address - Country:US
Mailing Address - Phone:361-854-2355
Mailing Address - Fax:361-854-5521
Practice Address - Street 1:1001 LOUISIANA AVE STE 304
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2861
Practice Address - Country:US
Practice Address - Phone:361-854-2355
Practice Address - Fax:361-854-5521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203222Z00000X, 335E00000X
TX1029460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087359801Medicaid
TX010665001Medicaid
TX010665001Medicaid
TX0883420001Medicare NSC