MEDICARE: KT SLP, PLLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1194195354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KT SLP, PLLC

Provider Business Mailing Address
First Line	:	3020 AVENUE Y
Second Line	:	APT 8E
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1452
Country	:	US
Telephone Number	:	347-527-6837
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 AVENUE Y
Second Line	:	APT 8E
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1452
Country	:	US
Telephone Number	:	347-527-6837
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	KRISTINA TURABELIDZE
Credential	:	M.S., CCC-SLP, TSSLD
Telephone Number	:	347-527-6837

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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