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General NPI Number Information
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NPI Number | 1720530496
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Entity Type | Organization
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Legal Business Name | PURE AUDIOLOGY LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 64 KNIGHT LN
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City | WILLISTON
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State | VT
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Zip | 05495-9480
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Country | US
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Telephone | 802-318-0138
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Fax | 866-649-2238
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Provider Business Mailing Address
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Address Line | PO BOX 186
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City | WILLISTON
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State | VT
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Zip | 05495-0186
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Country | US
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Telephone | 802-318-0138
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Fax | 866-649-2238
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. CHRISTINA JB BRADFORD
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Credential | AU.D.
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Telephone | 802-318-0138
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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 |
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License Number State | VT
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