=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447581806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODY EDWARDS CHESSER AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2010
-----------------------------------------------------
Last Update Date | 03/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 339 RACETRACK RD NW STE 20
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32547-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-863-4327
-----------------------------------------------------
Fax | 850-243-8741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 339 RACETRACK RD NW STE 20
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32547-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-863-4327
-----------------------------------------------------
Fax | 850-243-8741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AY1408
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------