MEDICARE: BROOKE VITA TOWNSEND AUD, 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	AY1113	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S9121	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1689792418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE VITA TOWNSEND AUD, CCC-A

Provider Business Mailing Address
First Line	:	744 CORAL DR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-5901
Country	:	US
Telephone Number	:	239-542-6732
Fax Number	:

Provider Business Practice Location Address
First Line	:	9732 COMMERCE CENTER CT
Second Line	:	UNIT A
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3647
Country	:	US
Telephone Number	:	239-332-0707
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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Directions to “ BROOKE VITA TOWNSEND AUD, CCC-A” Practice Location

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