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General NPI Number Information
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NPI Number | 1366486169
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Entity Type | Individual
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Provider Name | LAURA MICHELE CHURCH AU.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 2216 WOODMAN DR
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City | KETTERING
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State | OH
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Zip | 45420-1370
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Country | US
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Telephone | 937-222-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 954 THORNDALE DR
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City | DAYTON
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State | OH
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Zip | 45429-5828
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Country | US
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Telephone | 937-371-6084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number | A01213
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 231HA2500X
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Taxonomy Name | Assistive Technology Supplier Audiologist
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License Number | A01213
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | A01213
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License Number State | OH
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