=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174704209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEEHAN HEARING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 MORGAN FARMS DR
-----------------------------------------------------
City | SOUTH WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06074-1385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 869-644-7979
-----------------------------------------------------
Fax | 860-644-2710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 MORGAN FARMS DR
-----------------------------------------------------
City | SOUTH WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06074-1385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 869-644-7979
-----------------------------------------------------
Fax | 860-644-2710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST
-----------------------------------------------------
Name | MRS. BARBARA BRANT FEEHAN
-----------------------------------------------------
Credential | M.S., CCC-A
-----------------------------------------------------
Telephone | 860-644-7979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 000316
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------