=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609030782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND C WOITKOWSKI HIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2008
-----------------------------------------------------
Last Update Date | 07/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 86 YVONNE DR
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-7284
-----------------------------------------------------
Fax | 413-442-7284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 86 YVONNE DR
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-7284
-----------------------------------------------------
Fax | 413-442-7284
-----------------------------------------------------
=====================================================
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 | 251618
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 14000008903
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------