MEDICARE: SHANE LARKIN

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	237700000X	Hearing Instrument Specialist	6238741-4601	UT

General Provider Information

NPI Number	:	1790029023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE LARKIN

Provider Business Mailing Address
First Line	:	1528 WOODLAND PARK DR
Second Line	:	SUITE 100
City	:	LAYTON
State	:	UT
Zip	:	84041-5635
Country	:	US
Telephone Number	:	801-525-5254
Fax Number	:	801-525-2016

Provider Business Practice Location Address
First Line	:	1528 WOODLAND PARK DR
Second Line	:	SUITE 100
City	:	LAYTON
State	:	UT
Zip	:	84041-5635
Country	:	US
Telephone Number	:	801-525-5254
Fax Number	:	801-525-2016

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

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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Directions to “ SHANE LARKIN ” Practice Location

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