Healthcare Provider Details

I. General information

NPI: 1316034887
Provider Name (Legal Business Name): RICHARD WENDELL BOTHFELD AU.D., F-AAA, C-AAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 WATER ST
GARDINER ME
04345-2159
US

IV. Provider business mailing address

312 WATER ST
GARDINER ME
04345-2159
US

V. Phone/Fax

Practice location:
  • Phone: 207-481-9900
  • Fax: 207-536-5306
Mailing address:
  • Phone: 207-481-9900
  • Fax: 207-536-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP1990
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA441
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAP1990
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberA441
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA441
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAP1990
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: