MEDICARE: MARY KRISTI PLATTNER

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	100459	TX

General Provider Information

NPI Number	:	1487846713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KRISTI PLATTNER

Provider Business Mailing Address
First Line	:	225 MESQUITE DR
Second Line	:
City	:	LAGUNA VISTA
State	:	TX
Zip	:	78578-2708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 HWY 100 STE 9
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-2450
Country	:	US
Telephone Number	:	956-943-2248
Fax Number	:

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	08/10/2007

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Directions to “ MARY KRISTI PLATTNER ” Practice Location

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