Healthcare Provider Details

I. General information

NPI: 1194851345
Provider Name (Legal Business Name): TODD BLAKESLEE SAUTER M.A., F-AAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LINCOLN ST
WORCESTER MA
01605-2430
US

IV. Provider business mailing address

130 LINCOLN ST
WORCESTER MA
01605-2430
US

V. Phone/Fax

Practice location:
  • Phone: 508-792-9293
  • Fax:
Mailing address:
  • Phone: 508-792-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number717
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: