Healthcare Provider Details

I. General information

NPI: 1881288280
Provider Name (Legal Business Name): KARA A HOTALING AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LAFAYETTE AVE NE STE 204
GRAND RAPIDS MI
49503-1658
US

IV. Provider business mailing address

657 S WHITMAN CT SE
ADA MI
49301-7711
US

V. Phone/Fax

Practice location:
  • Phone: 616-331-5992
  • Fax:
Mailing address:
  • Phone: 616-570-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000558
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: