MEDICARE: MRS. KATHY JEAN GORMAN 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	237600000X	Audiologist-Hearing Aid Fitter	51598	TX

General Provider Information

NPI Number	:	1881674158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY JEAN GORMAN AUD, CCC-A

Provider Business Mailing Address
First Line	:	7355 N BEACH ST
Second Line	:	SUITE 165
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1897
Country	:	US
Telephone Number	:	817-847-1515
Fax Number	:	817-847-1542

Provider Business Practice Location Address
First Line	:	7355 N BEACH ST
Second Line	:	SUITE 165
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1897
Country	:	US
Telephone Number	:	817-847-1515
Fax Number	:	817-847-1542

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	04/18/2013

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