MEDICARE: MISS CARLI CAPPS

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	110902	TX

General Provider Information

NPI Number	:	1245637685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CARLI CAPPS

Provider Business Mailing Address
First Line	:	110 ROUNDABOUT DR
Second Line	:	SUITE A
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-1990
Country	:	US
Telephone Number	:	469-336-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 ROUNDABOUT DR
Second Line	:	SUITE A
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-1990
Country	:	US
Telephone Number	:	469-336-5010
Fax Number	:

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

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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Directions to “ MISS CARLI CAPPS ” Practice Location

Language	Start Address	Practice Location

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