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General NPI Number Information
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NPI Number | 1184938441
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Entity Type | Organization
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Legal Business Name | MAZE HEARING & BALANCE, LLC
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 500 LONDON AVE
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City | MARYSVILLE
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State | OH
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Zip | 43040-5512
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Country | US
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Telephone | 937-578-2362
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Fax | 937-578-2810
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Provider Business Mailing Address
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Address Line | 500 LONDON AVE
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City | MARYSVILLE
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State | OH
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Zip | 43040-5512
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Country | US
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Telephone | 937-578-2362
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Fax | 937-578-2810
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Authorized Official
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Title or Position | DOCTOR OF AUDIOLOGY
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Name | DR. HEATHER LYNN MAZE-SMITH
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Credential | AU.D.
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Telephone | 937-578-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | A00823
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License Number State | OH
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