Provider Demographics
NPI:1316034887
Name:BOTHFELD, RICHARD WENDELL (AUD, F-AAA, C-AAA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WENDELL
Last Name:BOTHFELD
Suffix:
Gender:M
Credentials:AUD, F-AAA, C-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHASE AVE
Mailing Address - Street 2:F.T. HILL CENTER
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4624
Mailing Address - Country:US
Mailing Address - Phone:207-872-4383
Mailing Address - Fax:207-872-4222
Practice Address - Street 1:30 CHASE AVE
Practice Address - Street 2:F.T. HILL CENTER
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4624
Practice Address - Country:US
Practice Address - Phone:207-872-4383
Practice Address - Fax:207-872-4222
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA441231H00000X, 231HA2500X, 237600000X
MEAP1990231H00000X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009099Medicaid
NH30210958Medicaid
ME001558401Medicare PIN
NH019064Medicare ID - Type UnspecifiedMEDICARE B