=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336569334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUND WAVES HEARING AID CENTER OF NEWPORT OREGON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2014
-----------------------------------------------------
Last Update Date | 04/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1460 N COAST HWY STE B
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-265-5285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1460 N COAST HWY STE B
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-265-5285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JANE STRAMPER
-----------------------------------------------------
Credential | A.A.S. HIS COHC
-----------------------------------------------------
Telephone | 541-265-5285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------