MEDICARE: MS. MARCIA SUE WAYMOUTH CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	4726	NC
2	237600000X	Audiologist-Hearing Aid Fitter	937	NC

General Provider Information

NPI Number	:	1003146051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA SUE WAYMOUTH CCC-A

Provider Business Mailing Address
First Line	:	13329 WILLOW BREEZE
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9621
Country	:	US
Telephone Number	:	704-987-8631
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 E SEVENTH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4375
Country	:	US
Telephone Number	:	704-376-1220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	01/13/2010

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