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General NPI Number Information
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NPI Number | 1356670970
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Entity Type | Organization
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Legal Business Name | MIRACLE EAR
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 1871 WELLS RD UNIT 1
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City | ORANGE PARK
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State | FL
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Zip | 32073-2371
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Country | US
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Telephone | 904-269-5700
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Fax | 904-269-9004
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Provider Business Mailing Address
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Address Line | 7171 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32504-6254
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Country | US
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Telephone | 850-474-5459
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Fax |
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Authorized Official
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Title or Position | PCC
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Name | MISS MELISSA MARIA CARLISLE
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Credential |
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Telephone | 850-474-5459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State | FL
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