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General NPI Number Information
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NPI Number | 1801982863
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Entity Type | Organization
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Legal Business Name | CHARLOTTE HEARING CENTER, INC.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21216 OLEAN BLVD SUITE 4
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6722
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Country | US
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Telephone | 941-766-8886
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Fax | 941-766-8804
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Provider Business Mailing Address
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Address Line | 21216 OLEAN BLVD SUITE 4
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6722
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Country | US
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Telephone | 941-766-8886
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Fax | 941-766-8804
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Authorized Official
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Title or Position | OWNER
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Name | BETHANY LEE WALDEN
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Credential | AU.D.
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Telephone | 941-766-8886
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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 | AY211
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License Number State | FL
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