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General NPI Number Information
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NPI Number | 1164879664
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Entity Type | Organization
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Legal Business Name | WOODBINE AUDIOLOGIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1811 BETHLEHEM PIKE SUITE 221
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City | FLOURTOWN
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State | PA
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Zip | 19031-1111
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Country | US
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Telephone | 215-858-7753
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 BETHLEHEM PIKE SUITE 221
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City | FLOURTOWN
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State | PA
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Zip | 19031-1111
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Country | US
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Telephone | 215-858-7753
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | LISA MARIELLO-BAIADA
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Credential | AUD
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Telephone | 215-858-7753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AT006311
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License Number State | PA
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