Healthcare Provider Details

I. General information

NPI: 1386694834
Provider Name (Legal Business Name): NATALIE R. KOONTZ MA,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WELLNESS WAY CAMERON WELLNESS CENTER
WASHINGTON PA
15301-9697
US

IV. Provider business mailing address

210 WELLNESS WAY CAMERON WELLNESS CENTER
WASHINGTON PA
15301-9697
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-8212
  • Fax: 724-228-7767
Mailing address:
  • Phone: 724-228-8212
  • Fax: 724-228-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT005860
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: