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NPI Code Detail

MEDICARE: MARIE HOLBROOK AUD

MEDICARE: MARIE HOLBROOK AUD
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
1231H00000XAudiologist80811TX
2237600000XAudiologist-Hearing Aid Fitter80811TX

General Provider Information

NPI Number : 1356714554
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE HOLBROOK AUD
Provider Business Mailing Address
First Line : PO BOX 99213
Second Line :
City : FORT WORTH
State : TX
Zip : 76199-0213
Country : US
Telephone Number : 682-885-4871
Fax Number : 682-885-3936
Provider Business Practice Location Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 682-885-4063
Fax Number : 682-885-1878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2015
Last Update Date : 11/10/2015

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Directions to “ MARIE HOLBROOK AUD” Practice Location

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