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General NPI Number Information
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NPI Number | 1760893473
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Entity Type | Organization
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Legal Business Name | MOUNTAINEER AUDIOLOGY LLC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 25029 NORTHWESTERN PIKE
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City | ROMNEY
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State | WV
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Zip | 26757-6203
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Country | US
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Telephone | 304-822-4334
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Fax | 304-822-4452
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Provider Business Mailing Address
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Address Line | 25029 NORTHWESTERN PIKE
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City | ROMNEY
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State | WV
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Zip | 26757-6203
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Country | US
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Telephone | 304-822-4334
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Fax | 304-822-4452
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Authorized Official
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Title or Position | AUDIOLOGIST/OWNER
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Name | DR. TARA DIANNE CRANE
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Credential | AUD
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Telephone | 304-822-4334
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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 | A-0070
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License Number State | WV
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