MEDICARE: RACHAEL LYNN KASS 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
1	231H00000X	Audiologist	A-0365	WV

General Provider Information

NPI Number	:	1477140978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL LYNN KASS AUD

Provider Business Mailing Address
First Line	:	211 W MAPLE AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1445
Country	:	US
Telephone Number	:	304-900-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 W MAPLE AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1445
Country	:	US
Telephone Number	:	304-900-5511
Fax Number	:

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	02/09/2023

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