=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386809366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAPLES NEUROPSYCHOLOGY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2008
-----------------------------------------------------
Last Update Date | 07/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2450 GOODLETTE RD N STE 101 NAPLES NEUROPSYCHOLOGY, P.A.
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-4595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-514-3003
-----------------------------------------------------
Fax | 239-514-7009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 679 110TH AVE N NAPLES NEUROPSYCHOLOGY, P.A.
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34108-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-514-3003
-----------------------------------------------------
Fax | 239-514-7009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT H OUAOU
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 239-514-3003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | PY6868
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------