Healthcare Provider Details

I. General information

NPI: 1477084531
Provider Name (Legal Business Name): MARTHA MARIE NELMS MS/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA MARIE NORWOOD MS/CCC-SLP

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 BRYANT IRVIN RD N 200
FORT WORTH TX
76107-7673
US

IV. Provider business mailing address

2001 N MACARTHUR BLVD STE 550
IRVING TX
75061
US

V. Phone/Fax

Practice location:
  • Phone: 817-738-9866
  • Fax: 817-738-3157
Mailing address:
  • Phone: 972-579-8155
  • Fax: 972-579-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: