Healthcare Provider Details

I. General information

NPI: 1194557959
Provider Name (Legal Business Name): MCKAYLA REPATH HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 WASHINGTON ST STE 102A
BROOKLINE MA
02445-7167
US

IV. Provider business mailing address

44 WASHINGTON ST STE 102A
BROOKLINE MA
02445-7167
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-9988
  • Fax: 617-232-6708
Mailing address:
  • Phone: 617-731-9988
  • Fax: 617-232-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHES6528
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: