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General NPI Number Information
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NPI Number | 1003316639
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Entity Type | Organization
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Legal Business Name | TIMBERLINE HEARING, P.C.
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 218 N BROADWAY AVE
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City | RIVERTON
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State | WY
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Zip | 82501-3543
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Country | US
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Telephone | 307-856-3847
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Fax | 307-856-7484
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Provider Business Mailing Address
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Address Line | 218 N BROADWAY AVE
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City | RIVERTON
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State | WY
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Zip | 82501-3543
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Country | US
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Telephone | 307-856-3847
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Fax | 307-856-7484
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Authorized Official
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Title or Position | OWNER/H.A. SPECIALIST/AUDIOLOGIST
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Name | PATRICIA E. JOHNSON
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Credential | M.A., CCC-A
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Telephone | 307-856-3847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 103
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License Number State | WY
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