Healthcare Provider Details

I. General information

NPI: 1417362898
Provider Name (Legal Business Name): DR. RACHEL COHEN AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13889 FARNESE DR
ESTERO FL
33928-5702
US

IV. Provider business mailing address

13889 FARNESE DR
ESTERO FL
33928-5702
US

V. Phone/Fax

Practice location:
  • Phone: 202-997-4045
  • Fax:
Mailing address:
  • Phone: 202-997-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1495
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: RACHEL COHEN
Title or Position: MBR/OWNER AUDIOLOGIST
Credential: AUD
Phone: 202-997-4045