Healthcare Provider Details

I. General information

NPI: 1225020969
Provider Name (Legal Business Name): MARILYN KAY LARKIN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADRID BLVD STE 315
PUNTA GORDA FL
33950-7968
US

IV. Provider business mailing address

3829 BERMUDA CT
PUNTA GORDA FL
33950-8123
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-0400
  • Fax: 941-505-0022
Mailing address:
  • Phone: 941-637-3950
  • Fax: 941-505-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY224
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: