MEDICARE: KYLIE MORSE-ROTH

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	117737	TX

General Provider Information

NPI Number	:	1659962793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE MORSE-ROTH

Provider Business Mailing Address
First Line	:	14540 FARM TO MARKET RD 1325
Second Line	:	APT #2725
City	:	AUSTIN
State	:	TX
Zip	:	78728
Country	:	US
Telephone Number	:	512-487-0237
Fax Number	:

Provider Business Practice Location Address
First Line	:	14540 FM 1325
Second Line	:	APT #2725
City	:	AUSTIN
State	:	TX
Zip	:	78728-7872
Country	:	US
Telephone Number	:	512-487-0237
Fax Number	:

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

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/01/2021

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Directions to “ KYLIE MORSE-ROTH ” Practice Location

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