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General NPI Number Information
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NPI Number | 1336913532
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Entity Type | Organization
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Legal Business Name | MARVEL OROFACIAL MYOFUNCTIONAL THERAPY
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 349 KELLER PKWY
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City | KELLER
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State | TX
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Zip | 76248-2266
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Country | US
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Telephone | 469-900-5448
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Fax |
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Provider Business Mailing Address
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Address Line | 349 KELLER PKWY
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City | KELLER
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State | TX
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Zip | 76248-2266
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Country | US
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Telephone | 469-900-5448
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST, OWNER
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Name | KATELYN SPENCER
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Credential | CCC-SLP
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Telephone | 469-900-5448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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