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General NPI Number Information
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NPI Number | 1679736680
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Entity Type | Individual
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Provider Name | TRAVIS DUANE QUILLER AU.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 10021 DUPONT CIRCLE CT
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City | FORT WAYNE
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State | IN
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Zip | 46825-1604
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Country | US
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Telephone | 260-426-8117
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Fax | 260-420-0817
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Provider Business Mailing Address
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Address Line | 10021 DUPONT CIRCLE CT
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City | FORT WAYNE
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State | IN
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Zip | 46825-1604
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Country | US
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Telephone | 260-426-8117
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Fax | 260-420-0817
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 8628
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number | 8628
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 231HA2500X
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Taxonomy Name | Assistive Technology Supplier Audiologist
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License Number | 8628
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 8628
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 8628
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 23002847A
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License Number State | IN
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Taxonomy #7
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number | 8628
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License Number State | NC
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