=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275909251
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. KAREN KIRTANI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2015
-----------------------------------------------------
Last Update Date | 08/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 456 PAYNE RD
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074-8200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-883-7874
-----------------------------------------------------
Fax | 207-883-7624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 456 PAYNE RD
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074-8200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-883-7874
-----------------------------------------------------
Fax | 207-883-7624
-----------------------------------------------------
=====================================================
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 | DL360
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------