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NPI Code Detail

MEDICARE: TAYLOR A AUTREY

MEDICARE:   TAYLOR A AUTREY
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
1237700000XHearing Instrument Specialist

General Provider Information

NPI Number : 1366714636
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR A AUTREY
Provider Business Mailing Address
First Line : 9529 FOUNDERS WAY
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-9232
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9529 FOUNDERS WAY
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-9232
Country : US
Telephone Number : 260-417-5564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2012
Last Update Date : 02/02/2012

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Directions to “ TAYLOR A AUTREY ” Practice Location

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