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General NPI Number Information
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NPI Number | 1497205736
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Entity Type | Organization
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Legal Business Name | HEARING EDUCATION ASSESMENT AND REHABILITATION MOBILE SERVICES
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 615 SE HIBISCUS AVE
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City | STUART
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State | FL
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Zip | 34996-3602
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Country | US
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Telephone | 772-696-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 615 SE HIBISCUS AVE
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City | STUART
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State | FL
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Zip | 34996-3602
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Country | US
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Telephone | 772-696-4327
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MICHAEL MACKINNON
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Credential | AUD
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Telephone | 772-696-4327
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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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