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General NPI Number Information
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NPI Number | 1801374012
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Entity Type | Organization
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Legal Business Name | HOMETOWN HEARING CARE, INC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 4297 3RD AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2136
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Country | US
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Telephone | 850-372-4468
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Fax | 850-394-4120
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Provider Business Mailing Address
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Address Line | 4297 3RD AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2136
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Country | US
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Telephone | 850-372-4468
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Fax | 850-394-4120
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Authorized Official
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Title or Position | OWNER/AUDIOLOGIST
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Name | LARRY O OTWELL X
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Credential | AU.D., CCC-A
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Telephone | 850-372-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number | AY370
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License Number State | FL
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