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General NPI Number Information
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NPI Number | 1952581084
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Entity Type | Organization
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Legal Business Name | RUSSELL T. TERRILL AUD
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 4677 VALLEY EAST BLVD. SUITE 2
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City | ARCATA
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State | CA
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Zip | 95521-0000
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Country | US
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Telephone | 707-822-9122
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Fax | 707-822-1969
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Provider Business Mailing Address
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Address Line | 4677 VALLEY EAST BLVD SUITE 2
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City | ARCATA
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State | CA
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Zip | 95521-0000
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Country | US
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Telephone | 707-822-9122
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Fax | 707-822-1969
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Authorized Official
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Title or Position | OWNER/AUDIOLOGIST
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Name | DR. RUSSELL T TERRILL
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Credential | AUD
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Telephone | 707-822-9122
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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 | AU1484
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | HA7245
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | HA7255
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU2015
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License Number State | CA
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