MEDICARE: REBECCA BROCK KOHOUT AU.D.

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	80555	TX
2	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1497167662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BROCK KOHOUT AU.D.

Provider Business Mailing Address
First Line	:	12900 QUEENSBURY LN
Second Line	:	STE 100
City	:	HOUSTON
State	:	TX
Zip	:	77079-3713
Country	:	US
Telephone Number	:	713-827-1767
Fax Number	:	713-827-1984

Provider Business Practice Location Address
First Line	:	12900 QUEENSBURY LN
Second Line	:	STE 100
City	:	HOUSTON
State	:	TX
Zip	:	77079-3713
Country	:	US
Telephone Number	:	713-827-1767
Fax Number	:	713-827-1984

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

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	05/04/2016

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