MEDICARE: DR. KATHRYN MARIE NETHERY AUD

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	1118	WA
2	237600000X	Audiologist-Hearing Aid Fitter	1118	WA

General Provider Information

NPI Number	:	1811996499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN MARIE NETHERY AUD

Provider Business Mailing Address
First Line	:	1 BOONE RD
Second Line	:	ROOM 2009
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	360-475-4298
Fax Number	:	360-475-4156

Provider Business Practice Location Address
First Line	:	1 BOONE RD
Second Line	:	ROOM 2009
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	360-475-4298
Fax Number	:	360-475-4156

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/27/2015

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