Healthcare Provider Details

I. General information

NPI: 1467894436
Provider Name (Legal Business Name): BRITTANY SPAHR FISCHTZIUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5402 W ALOHA DR
DIAMONDHEAD MS
39525-3329
US

IV. Provider business mailing address

5439 W ALOHA DR SUITE B
DIAMONDHEAD MS
39525-3379
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-8889
  • Fax: 228-255-0890
Mailing address:
  • Phone: 228-255-8889
  • Fax: 228-255-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1115A
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA4207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: