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General NPI Number Information
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NPI Number | 1083888697
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Entity Type | Individual
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Provider Name | MANDY LEIGH RAISCH AU.D.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 110 B TOWN COMMONS DRIVE
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City | SHELBY
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State | NC
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Zip | 28152-2815
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Country | US
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Telephone | 704-313-0204
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Fax | 704-313-0194
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Provider Business Mailing Address
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Address Line | 1330 BOILING SPRINGS RD SUITE 1400
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City | SPARTANBURG
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State | SC
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Zip | 29303-4201
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Country | US
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Telephone | 864-278-1446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 5852
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License Number State | NC
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