MEDICARE: KATHERINE HOPE ELLISON

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	237700000X	Hearing Instrument Specialist	1224	FL

General Provider Information

NPI Number	:	1356035133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE HOPE ELLISON

Provider Business Mailing Address
First Line	:	2513 KAILEEN CIR NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3005
Country	:	US
Telephone Number	:	321-480-4108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2243 W NEW HAVEN AVE STE 102
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-3832
Country	:	US
Telephone Number	:	321-354-9207
Fax Number	:

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/06/2023

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