Healthcare Provider Details

I. General information

NPI: 1558807180
Provider Name (Legal Business Name): ATLANTIC AUDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE SUITE 305B
CRANSTON RI
02920-6068
US

IV. Provider business mailing address

1150 RESERVOIR AVE SUITE 305B
CRANSTON RI
02920-6068
US

V. Phone/Fax

Practice location:
  • Phone: 401-942-8080
  • Fax: 401-942-3666
Mailing address:
  • Phone: 401-942-8080
  • Fax: 401-942-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD00181
License Number StateRI

VIII. Authorized Official

Name: DR. MICHELINE MONETTE GAUTHIER
Title or Position: OWNER
Credential: AU.D.
Phone: 401-663-3370