Healthcare Provider Details

I. General information

NPI: 1902039464
Provider Name (Legal Business Name): KLAMATH AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N 4TH ST
KLAMATH FALLS OR
97601-6320
US

IV. Provider business mailing address

123 N 4TH ST
KLAMATH FALLS OR
97601-6320
US

V. Phone/Fax

Practice location:
  • Phone: 541-884-6101
  • Fax: 541-882-4167
Mailing address:
  • Phone: 541-884-6101
  • Fax: 541-882-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number22922
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA ANN TOLSTIKHINE
Title or Position: OWNER/ AUDIOLOGIST
Credential: AUD
Phone: 541-884-6101