Healthcare Provider Details

I. General information

NPI: 1255861506
Provider Name (Legal Business Name): JULIE A PETERS H.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7536 SLATE RIDGE BLVD
REYNOLDSBURG OH
43068-3156
US

IV. Provider business mailing address

7536 SLATE RIDGE BLVD
REYNOLDSBURG OH
43068-3156
US

V. Phone/Fax

Practice location:
  • Phone: 614-755-5125
  • Fax: 614-755-5129
Mailing address:
  • Phone: 614-755-5125
  • Fax: 614-755-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number03122
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: