MEDICARE: MS. CAROLYN KASBEER COULTER R.D., L.D

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	133V00000X	Registered Dietitian	DT81309	TX

General Provider Information

NPI Number	:	1538486048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN KASBEER COULTER R.D., L.D

Provider Business Mailing Address
First Line	:	550 WESTLAKE PARK BLVD
Second Line	:	ROOM 1067
City	:	HOUSTON
State	:	TX
Zip	:	77079-2661
Country	:	US
Telephone Number	:	281-366-0799
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 WESTLAKE PARK BLVD
Second Line	:	ROOM 1067
City	:	HOUSTON
State	:	TX
Zip	:	77079-2661
Country	:	US
Telephone Number	:	281-366-0799
Fax Number	:

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

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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