Provider Demographics
NPI:1407183981
Name:AMY K. ROTHERMEL AU.D. LLC
Entity Type:Organization
Organization Name:AMY K. ROTHERMEL AU.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:ROTHERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:760-375-9399
Mailing Address - Street 1:121 S CHINA LAKE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-4049
Mailing Address - Country:US
Mailing Address - Phone:760-375-9399
Mailing Address - Fax:760-375-9499
Practice Address - Street 1:121 S CHINA LAKE BLVD STE B
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-4049
Practice Address - Country:US
Practice Address - Phone:760-375-9399
Practice Address - Fax:760-375-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2288231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty