MEDICARE: KATE ELIZABETH WOOTEN 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	AY1764	FL

General Provider Information

NPI Number	:	1689918260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE ELIZABETH WOOTEN AU. D

Provider Business Mailing Address
First Line	:	8907 S INDIAN RIVER DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7823
Country	:	US
Telephone Number	:	248-535-4427
Fax Number	:

Provider Business Practice Location Address
First Line	:	8907 S INDIAN RIVER DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7823
Country	:	US
Telephone Number	:	248-535-4427
Fax Number	:

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

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/06/2023

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