MEDICARE: ANDREA SEIBOLD AUD

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	80069	TX

General Provider Information

NPI Number	:	1821322470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SEIBOLD AUD

Provider Business Mailing Address
First Line	:	PO BOX 716
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76244-0716
Country	:	US
Telephone Number	:	817-605-7544
Fax Number	:

Provider Business Practice Location Address
First Line	:	5449 LAKE POWELL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4341
Country	:	US
Telephone Number	:	817-605-7544
Fax Number	:

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

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	06/21/2013

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