Healthcare Provider Details

I. General information

NPI: 1952403727
Provider Name (Legal Business Name): DANIEL JOSEPH TIBBS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10134 OXFORD DR
PICKERINGTON OH
43147-8905
US

IV. Provider business mailing address

10134 OXFORD DR
PICKERINGTON OH
43147-8905
US

V. Phone/Fax

Practice location:
  • Phone: 614-314-4516
  • Fax:
Mailing address:
  • Phone: 614-314-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA 01578
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberA 01578
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberA 01578
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA 01578
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: