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General NPI Number Information
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NPI Number | 1609897024
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Entity Type | Individual
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Provider Name | COLLEEN M KEITH MACCCA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 560 W MITCHELL ST SUITE 250
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City | PETOSKEY
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State | MI
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Zip | 49770-2275
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Country | US
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Telephone | 231-439-6844
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Fax | 231-487-0728
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Provider Business Mailing Address
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Address Line | 560 W MITCHELL ST SUITE 250
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City | PETOSKEY
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State | MI
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Zip | 49770-2275
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Country | US
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Telephone | 231-439-6844
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Fax | 231-487-0728
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 1601000006
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License Number State | MI
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