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General NPI Number Information
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NPI Number | 1548550635
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Entity Type | Organization
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Legal Business Name | GREAT SCOTT AUDIOLOGY, PA
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 331 MAINE ST SUITE 4
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City | BRUNSWICK
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State | ME
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Zip | 04011-3358
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Country | US
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Telephone | 207-729-4086
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Fax | 207-449-1193
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Provider Business Mailing Address
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Address Line | 331 MAINE ST SUITE 4
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City | BRUNSWICK
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State | ME
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Zip | 04011-3358
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Country | US
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Telephone | 207-729-4086
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Fax | 207-449-1193
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Authorized Official
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Title or Position | AUDIOLOGIST/PRESIDENT
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Name | DR. CRISTIN R RICHARDS
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Credential | AU.D.
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Telephone | 207-729-4086
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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 | AP1273
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License Number State | ME
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