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General NPI Number Information
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NPI Number | 1396474656
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Entity Type | Individual
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Provider Name | EMILY ROSE MOTT AUD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 2422 W MAIN ST UNIT 3A
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City | ST CHARLES
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State | IL
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Zip | 60175-1010
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Country | US
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Telephone | 630-513-5012
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Fax |
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Provider Business Mailing Address
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Address Line | 605 CIRCLE AVE
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City | FOREST PARK
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State | IL
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Zip | 60130-1932
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Country | US
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Telephone | 708-328-0461
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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