MEDICARE: MOLLY WHEELER SLP

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	SP#8562	AR
2	235Z00000X	Speech-Language Pathologist	110280	TX

General Provider Information

NPI Number	:	1528317088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY WHEELER SLP

Provider Business Mailing Address
First Line	:	1325 STEINBURG LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3402
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 STEINBURG LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3402
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	07/17/2014

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Directions to “ MOLLY WHEELER SLP” Practice Location

Language	Start Address	Practice Location

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