MEDICARE: KATHRYN BOX

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	235Z00000X	Speech-Language Pathologist	108358	TX

General Provider Information

NPI Number	:	1255027744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BOX

Provider Business Mailing Address
First Line	:	7301 MADEIRA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-4307
Country	:	US
Telephone Number	:	313-269-0322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 BARRON LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-4230
Country	:	US
Telephone Number	:	817-815-4800
Fax Number	:

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

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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Directions to “ KATHRYN BOX ” Practice Location

Language	Start Address	Practice Location

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