Healthcare Provider Details

I. General information

NPI: 1598808149
Provider Name (Legal Business Name): CHRISTINE M BOND-EAVES MA CCCA A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN STREET SUITE 211
MEDFORD MA
02155
US

IV. Provider business mailing address

101 MAIN ST SUITE 211
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-874-1968
  • Fax: 781-874-1967
Mailing address:
  • Phone: 781-874-1968
  • Fax: 781-874-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number317
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: