=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154813665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TABITHA A CUTSINGER HIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2018
-----------------------------------------------------
Last Update Date | 05/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 MEADOWS SHOPPING CTR
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47803-2373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-234-9332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 WHITE OAK LN
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47804-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-677-1098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 17001445A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------