=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104667492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISON MARIE REYNOLDS AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 SE CARY PKWY STE 104
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27518-7417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-626-2998
-----------------------------------------------------
Fax | 877-771-3406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5041 EXECUTIVE DR STE 100
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-773-0636
-----------------------------------------------------
Fax | 877-771-3406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 30002901
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 30002901
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------