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General NPI Number Information
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NPI Number | 1225224678
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Entity Type | Individual
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Provider Name | DAN E HARTLEY SR. STATE LICENSED HEARI
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Gender | Male
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 502 PEVELY MANOR SUITE 1
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City | PEVELY
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State | MO
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Zip | 63070
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Country | US
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Telephone | 636-479-9556
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX C
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City | PARK HILLS
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State | MO
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Zip | 63601
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Country | US
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Telephone | 573-431-2717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 894
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License Number State | MO
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