Healthcare Provider Details

I. General information

NPI: 1295115459
Provider Name (Legal Business Name): BRADLEY NEIL CASTO HEARING INSTRUMENT S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 EAST CENTER ST
MARION OH
43302
US

IV. Provider business mailing address

864 EAST CENTER ST
MARION OH
43302
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-4553
  • Fax: 740-382-9474
Mailing address:
  • Phone: 740-382-4553
  • Fax: 740-382-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: