=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336600659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. KAYLA MARIE ROGERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2019
-----------------------------------------------------
Last Update Date | 03/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8975 DARROW RD
-----------------------------------------------------
City | TWINSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44087-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-425-1339
-----------------------------------------------------
Fax | 330-425-1351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8975 DARROW RD
-----------------------------------------------------
City | TWINSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44087-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-606-8294
-----------------------------------------------------
Fax | 330-425-1351
-----------------------------------------------------
=====================================================
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 | 3352
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------