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General NPI Number Information
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NPI Number | 1124118229
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Entity Type | Organization
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Legal Business Name | CHMC OTOLARYNGOLOGIC FOUNDATION, INC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 300 LONGWOOD AVE
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City | BOSTON
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State | MA
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Zip | 02115-5724
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Country | US
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Telephone | 617-355-6460
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Fax | 617-730-0611
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Provider Business Mailing Address
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Address Line | PO BOX 4162
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City | WOBURN
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State | MA
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Zip | 01888-4162
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Country | US
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Telephone | 617-355-6460
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Fax | 617-730-0611
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANAGER
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Name | KATHLEEN M HICKEY
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Credential |
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Telephone | 617-355-4956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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