=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598886319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLLYN SUE REEVES BC-HIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 S MAIN ST
-----------------------------------------------------
City | CORBIN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40701-1453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-528-1136
-----------------------------------------------------
Fax | 606-528-4758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 S MAIN ST
-----------------------------------------------------
City | CORBIN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40701-1453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-528-1136
-----------------------------------------------------
Fax | 606-528-4758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 0218
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------