Healthcare Provider Details

I. General information

NPI: 1003239153
Provider Name (Legal Business Name): KRISTINA FASSETT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6562 WESTON CIR E
DUBLIN OH
43016-9442
US

IV. Provider business mailing address

6562 WESTON CIR E
DUBLIN OH
43016-9442
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-5727
  • Fax:
Mailing address:
  • Phone: 614-873-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.01554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: