MEDICARE: MR. LISA R WESTBROOK M.ED, CCC-A

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	237600000X	Audiologist-Hearing Aid Fitter	2201001094	VA
2	237600000X	Audiologist-Hearing Aid Fitter	2101001313	VA

General Provider Information

NPI Number	:	1558553826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LISA R WESTBROOK M.ED, CCC-A

Provider Business Mailing Address
First Line	:	339 LUCY DR
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8050
Country	:	US
Telephone Number	:	540-434-3977
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 VALLEY AVE
Second Line	:	SUITE 105A
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2656
Country	:	US
Telephone Number	:	540-434-3977
Fax Number	:

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	08/10/2007

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