MEDICARE: MS. LARRY A. BRAND H.I.S.

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	237700000X	Hearing Instrument Specialist	F03068	PA

General Provider Information

NPI Number	:	1518151166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARRY A. BRAND H.I.S.

Provider Business Mailing Address
First Line	:	142 WELLES ST
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4970
Country	:	US
Telephone Number	:	570-287-6606
Fax Number	:	570-287-6833

Provider Business Practice Location Address
First Line	:	142 WELLES ST
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4970
Country	:	US
Telephone Number	:	570-287-6606
Fax Number	:	570-287-6833

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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