Healthcare Provider Details

I. General information

NPI: 1104942002
Provider Name (Legal Business Name): FELICIA BOUBIN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S PATTERSON BLVD STE 400
DAYTON OH
45402-2642
US

IV. Provider business mailing address

1222 S PATTERSON BLVD STE 400
DAYTON OH
45402-2642
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2620
  • Fax: 937-424-8518
Mailing address:
  • Phone: 937-496-2620
  • Fax: 937-424-8518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA0531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: