MEDICARE: SCOTT HARRIS

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

General Provider Information

NPI Number	:	1356576821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT HARRIS

Provider Business Mailing Address
First Line	:	1515 N 400 E
Second Line	:	SUITE 105
City	:	LOGAN
State	:	UT
Zip	:	84341-7561
Country	:	US
Telephone Number	:	435-787-8895
Fax Number	:	435-787-8654

Provider Business Practice Location Address
First Line	:	1515 N 400 E
Second Line	:	SUITE 105
City	:	LOGAN
State	:	UT
Zip	:	84341-7561
Country	:	US
Telephone Number	:	435-787-8895
Fax Number	:	435-787-8654

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/27/2009

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Directions to “ SCOTT HARRIS ” Practice Location

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