MEDICARE: MRS. LORI KATHLEEN KAY MA CCCA FAAA

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	237600000X	Audiologist-Hearing Aid Fitter	3138	NM
2	231H00000X	Audiologist	80276	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346348349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI KATHLEEN KAY MA CCCA FAAA

Provider Business Mailing Address
First Line	:	7920 WYOMING BLVD NE
Second Line	:	STE A
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6020
Country	:	US
Telephone Number	:	505-821-6715
Fax Number	:	505-821-0839

Provider Business Practice Location Address
First Line	:	5800 CAMP BOWIE BLVD
Second Line	:	STE 126
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5057
Country	:	US
Telephone Number	:	817-870-2500
Fax Number	:	817-870-1382

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/27/2014

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