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General NPI Number Information
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NPI Number | 1053633438
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Entity Type | Organization
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Legal Business Name | GEMMA WALL LLC
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 08/09/2017
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Provider Practice Location Address
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Address Line | 16103 W LITTLE YORK RD SUITE F
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City | HOUSTON
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State | TX
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Zip | 77084-6868
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Country | US
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Telephone | 281-855-8916
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Fax | 281-855-9193
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Provider Business Mailing Address
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Address Line | 16103 W LITTLE YORK RD SUITE F
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City | HOUSTON
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State | TX
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Zip | 77084-6868
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Country | US
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Telephone | 281-855-8916
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Fax | 281-855-9193
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEMMA SICAM WALL
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Credential | AUD
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Telephone | 281-855-8916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 50426
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 50426
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License Number State | TX
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