Healthcare Provider Details

I. General information

NPI: 1043452048
Provider Name (Legal Business Name): LORI A DAVIDSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 AUBURN ROAD #103
PAINESVILLE OH
44077
US

IV. Provider business mailing address

7580 AUBURN ROAD #103
PAINESVILLE OH
44077
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-1474
  • Fax: 440-352-2662
Mailing address:
  • Phone: 440-352-1474
  • Fax: 440-352-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA01288
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA01288
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: