Healthcare Provider Details

I. General information

NPI: 1487952016
Provider Name (Legal Business Name): CHRISTOPHER HUTCHINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W EAU GALLIE BLVD STE 110
MELBOURNE FL
32935-3134
US

IV. Provider business mailing address

2290 W EAU GALLIE BLVD STE 110
MELBOURNE FL
32935-3134
US

V. Phone/Fax

Practice location:
  • Phone: 321-421-7555
  • Fax: 321-421-7553
Mailing address:
  • Phone: 321-421-7555
  • Fax: 321-421-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: