MEDICARE: CARTER THERAPY

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	18647	TX

General Provider Information

NPI Number	:	1548446131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTER THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 100722
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-0722
Country	:	US
Telephone Number	:	817-247-0654
Fax Number	:	817-847-0205

Provider Business Practice Location Address
First Line	:	3600 HULEN ST
Second Line	:	SUITE D-1
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6863
Country	:	US
Telephone Number	:	817-247-0654
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MS. MARILYN ANN CARTER
Credential	:	SLP
Telephone Number	:	817-247-0654

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	06/21/2010

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Directions to “CARTER THERAPY ” Practice Location

Language	Start Address	Practice Location

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