MEDICARE: DR. MARY O THORPE AU.D.

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	AY165	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S0919	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1083617864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY O THORPE AU.D.

Provider Business Mailing Address
First Line	:	2800 HILLVIEW STREET
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-3221
Country	:	US
Telephone Number	:	941-316-0406
Fax Number	:	941-316-9317

Provider Business Practice Location Address
First Line	:	2800 HILLVIEW STREET
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-3221
Country	:	US
Telephone Number	:	941-316-0406
Fax Number	:	941-316-9317

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/16/2012

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