Healthcare Provider Details

I. General information

NPI: 1255619748
Provider Name (Legal Business Name): ASHLEY BOYNTON THOM AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EXCHANGE PL
LAFAYETTE LA
70503-2580
US

IV. Provider business mailing address

110 EXCHANGE PL
LAFAYETTE LA
70503-2580
US

V. Phone/Fax

Practice location:
  • Phone: 337-291-9939
  • Fax: 337-291-9023
Mailing address:
  • Phone: 337-291-9939
  • Fax: 337-291-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number6508
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: