Provider Demographics
NPI:1487674321
Name:AUDIOLOGICAL REHABILITATIVE LABORATORY, INC
Entity Type:Organization
Organization Name:AUDIOLOGICAL REHABILITATIVE LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC-A
Authorized Official - Phone:850-878-7228
Mailing Address - Street 1:1614 MAHAN CENTER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5474
Mailing Address - Country:US
Mailing Address - Phone:850-878-7228
Mailing Address - Fax:850-877-5583
Practice Address - Street 1:1614 MAHAN CENTER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5474
Practice Address - Country:US
Practice Address - Phone:850-878-7228
Practice Address - Fax:850-877-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY430OtherSTATE LICENSE NUMBER
FLS0938Medicare ID - Type UnspecifiedPROVIDER NUMBER