=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003160938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMIE MICHELLE HANEY H.I.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2012
-----------------------------------------------------
Last Update Date | 10/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 HAPPY VALLEY RD
-----------------------------------------------------
City | GLASGOW
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42141-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-659-0232
-----------------------------------------------------
Fax | 270-659-0170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 521 HAPPY VALLEY RD
-----------------------------------------------------
City | GLASGOW
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42141-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-659-0232
-----------------------------------------------------
Fax | 270-659-0170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | KY-11-14
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------