=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316451289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOBLE HEARING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2017
-----------------------------------------------------
Last Update Date | 11/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 UPTOWN BLVD STE 2000
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75104-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-504-3644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 623 GREEN MEADOWS LN
-----------------------------------------------------
City | OVILLA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75154-1474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-994-1856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/AUDIOLOGIST
-----------------------------------------------------
Name | MARYLYN KOBLE
-----------------------------------------------------
Credential | M.S., CCC-A
-----------------------------------------------------
Telephone | 817-504-3644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 51286
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------