MEDICARE: HAZEL MARTINEZ KOPF SLP-A

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	2355S0801X	Speech-Language Assistant	35476	TX

General Provider Information

NPI Number	:	1043976236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZEL MARTINEZ KOPF SLP-A

Provider Business Mailing Address
First Line	:	3204 WESTFIELD AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1734
Country	:	US
Telephone Number	:	817-709-3581
Fax Number	:

Provider Business Practice Location Address
First Line	:	3204 WESTFIELD AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1734
Country	:	US
Telephone Number	:	817-709-3581
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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Directions to “ HAZEL MARTINEZ KOPF SLP-A” Practice Location

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