Healthcare Provider Details

I. General information

NPI: 1700899986
Provider Name (Legal Business Name): MARY KAY UCHMANOWICZ CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 DOUGLAS PIKE
SMITHFIELD RI
02917
US

IV. Provider business mailing address

151 DOUGLAS PIKE
SMITHFIELD RI
02917
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-0456
  • Fax: 401-349-0457
Mailing address:
  • Phone: 401-349-0456
  • Fax: 401-349-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00085
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: