Healthcare Provider Details

I. General information

NPI: 1053869016
Provider Name (Legal Business Name): MARK KRUMM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CHRISTY DR
CUYAHOGA FALLS OH
44223-3353
US

IV. Provider business mailing address

151 CHRISTY DR
CUYAHOGA FALLS OH
44223-3353
US

V. Phone/Fax

Practice location:
  • Phone: 330-510-6409
  • Fax:
Mailing address:
  • Phone: 330-510-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA01546
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberA01546
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA01546
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberA01546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: