MEDICARE: MARLO BAILEY LAWRENCE 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	237600000X	Audiologist-Hearing Aid Fitter	A01360	OH

General Provider Information

NPI Number	:	1851471973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLO BAILEY LAWRENCE AUD

Provider Business Mailing Address
First Line	:	9723 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7207
Country	:	US
Telephone Number	:	513-675-8595
Fax Number	:	513-793-9576

Provider Business Practice Location Address
First Line	:	9723 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7207
Country	:	US
Telephone Number	:	513-675-8595
Fax Number	:	513-793-9576

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/31/2015

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