Healthcare Provider Details

I. General information

NPI: 1346424777
Provider Name (Legal Business Name): CAROL ANN ZOMBOTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 07/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 FOUNDRY ST
NEW MARTINSVILLE WV
26155-1142
US

IV. Provider business mailing address

46 NORTHGATE DR
NEW MARTINSVILLE WV
26155-2814
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-2441
  • Fax: 304-455-3446
Mailing address:
  • Phone: 304-771-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6110
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: