=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669484150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY SUE KAPLAN PH.D., CCC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 CARLTON ST
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30602-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-542-4598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1121 ROCKY BRANCH FARM DR
-----------------------------------------------------
City | BOGART
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30622-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-769-3798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 3484
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------