MEDICARE: MRS. MARTHA GRAVES A.U.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	51734	TX
2	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1558412171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA GRAVES A.U.D.

Provider Business Mailing Address
First Line	:	400 S HENDERSON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1017
Country	:	US
Telephone Number	:	817-335-2583
Fax Number	:	817-335-2597

Provider Business Practice Location Address
First Line	:	3023 THOUSAND OAKS DR
Second Line	:	SUITE 105
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3556
Country	:	US
Telephone Number	:	210-494-2525
Fax Number	:	210-494-2526

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	04/25/2012

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