MEDICARE: MS. REBECCA THOMPSON

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	237700000X	Hearing Instrument Specialist	AS5105	FL

General Provider Information

NPI Number	:	1942676200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA THOMPSON

Provider Business Mailing Address
First Line	:	990 N STATE ROAD 434
Second Line	:	SUITE 1144
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7035
Country	:	US
Telephone Number	:	407-682-1674
Fax Number	:	407-682-2170

Provider Business Practice Location Address
First Line	:	990 N STATE ROAD 434
Second Line	:	SUITE 1144
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7035
Country	:	US
Telephone Number	:	407-682-1674
Fax Number	:	407-682-2170

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

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	08/20/2015

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