MEDICARE: MRS. KIMLEY SHEA MARQUARDT M.S., CCC-A

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	231H00000X	Audiologist	51421	TX
2	237600000X	Audiologist-Hearing Aid Fitter	51421	TX

General Provider Information

NPI Number	:	1518926104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMLEY SHEA MARQUARDT M.S., CCC-A

Provider Business Mailing Address
First Line	:	10740 N GESSNER DR
Second Line	:	STE 310
City	:	HOUSTON
State	:	TX
Zip	:	77064-1240
Country	:	US
Telephone Number	:	281-897-0416
Fax Number	:	281-890-8908

Provider Business Practice Location Address
First Line	:	17070 RED OAK DR
Second Line	:	STE 205
City	:	HOUSTON
State	:	TX
Zip	:	77090-2615
Country	:	US
Telephone Number	:	281-440-0734
Fax Number	:	281-440-8065

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/27/2010

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