=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275948820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAHLI BLAIR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2014
-----------------------------------------------------
Last Update Date | 06/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1719 S LOOP 288 STE. 165
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76205-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-566-2425
-----------------------------------------------------
Fax | 940-566-2425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 SHUMAN BLVD STE. 401
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-8458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-303-5380
-----------------------------------------------------
Fax | 978-313-6824
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------