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General NPI Number Information
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NPI Number | 1821646100
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Entity Type | Individual
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Provider Name | MARY KATHERINE MARSHALLSEA AU.D.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 7777 FOREST LN STE A103
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 972-566-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN STE A103
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City | DALLAS
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State | TX
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Zip | 75230-6800
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Country | US
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Telephone | 205-826-2075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 81171
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License Number State | TX
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