MEDICARE: MRS. MARCY G. O'BRIEN M.A. CCC-A, F-AAA

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	AY265	FL

General Provider Information

NPI Number	:	1659551315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCY G. O'BRIEN M.A. CCC-A, F-AAA

Provider Business Mailing Address
First Line	:	515 E GARDEN ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4615
Country	:	US
Telephone Number	:	863-683-5454
Fax Number	:	863-683-4652

Provider Business Practice Location Address
First Line	:	515 E GARDEN ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4615
Country	:	US
Telephone Number	:	863-683-5454
Fax Number	:	863-683-4652

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

Provider Enumeration Date	:	11/10/2007
Last Update Date	:	11/10/2007

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