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NPI Code Detail

MEDICARE: MRS. KATIE ROSE SHORT

MEDICARE:  MRS. KATIE ROSE SHORT
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
1235Z00000XSpeech-Language PathologistSZ 4431FL

General Provider Information

NPI Number : 1063681401
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATIE ROSE SHORT
Provider Business Mailing Address
First Line : 405 S SEMINOLE AVE
Second Line :
City : MINNEOLA
State : FL
Zip : 34715-5520
Country : US
Telephone Number : 352-408-5572
Fax Number :
Provider Business Practice Location Address
First Line : 405 S SEMINOLE AVE
Second Line :
City : MINNEOLA
State : FL
Zip : 34715-5520
Country : US
Telephone Number : 352-408-5572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2008
Last Update Date : 02/28/2008

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Directions to “ MRS. KATIE ROSE SHORT ” Practice Location

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