MEDICARE: MS. CARLA SEAMONS

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	231H00000X	Audiologist	111339-4101	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111339-4101	OTHER	UT	STATE LICENSE
2	01070999	OTHER	UT	AMER. SPEECH/ HEARING AS.

General Provider Information

NPI Number	:	1043484223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA SEAMONS

Provider Business Mailing Address
First Line	:	2380 N 400 E STE D
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1756
Country	:	US
Telephone Number	:	435-753-7880
Fax Number	:	435-753-5845

Provider Business Practice Location Address
First Line	:	2380 N 400 E STE D
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1756
Country	:	US
Telephone Number	:	435-753-7880
Fax Number	:	435-753-5845

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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