Provider Demographics
NPI:1114970449
Name:OOTSCAN AUDIOLOGY, PSC
Entity Type:Organization
Organization Name:OOTSCAN AUDIOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:KOLODZIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:787-756-6560
Mailing Address - Street 1:AVE ROOSEVELT
Mailing Address - Street 2:TORRE PLAZA LAS AMERICAS SUITE 402 CUARTO PISO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2710
Mailing Address - Country:US
Mailing Address - Phone:787-756-6560
Mailing Address - Fax:787-756-7456
Practice Address - Street 1:AVE ROOSEVELT
Practice Address - Street 2:TORRE PLAZA LAS AMERICAS SUITE 402 CUARTO PISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-2710
Practice Address - Country:US
Practice Address - Phone:787-756-6560
Practice Address - Fax:787-756-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR505261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ46965Medicare UPIN