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General NPI Number Information
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NPI Number | 1083803761
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Entity Type | Organization
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Legal Business Name | WIND RIVER HEARING SERVICES
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 269 GARFIELD ST
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City | LANDER
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State | WY
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Zip | 82520-3121
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Country | US
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Telephone | 307-332-0284
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Fax | 307-332-6334
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Provider Business Mailing Address
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Address Line | 269 GARFIELD ST
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City | LANDER
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State | WY
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Zip | 82520-3121
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Country | US
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Telephone | 307-332-0284
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Fax | 307-332-6334
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | CELESTA CARTRITE KOMRS
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Credential | M.S.,CCC/A
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Telephone | 307-332-0284
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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 | A964
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License Number State | WY
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