MEDICARE: KELSEY CUTLER

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

General Provider Information

NPI Number	:	1023754140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY CUTLER

Provider Business Mailing Address
First Line	:	4815 RYE GLEN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-2345
Country	:	US
Telephone Number	:	817-909-8480
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 RYE GLEN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-2345
Country	:	US
Telephone Number	:	817-909-8480
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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Directions to “ KELSEY CUTLER ” Practice Location

Language	Start Address	Practice Location

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