Provider Demographics
NPI:1518526276
Name:TOOHEY, MATTHEW (BC-HIS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TOOHEY
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CAMELLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4657
Mailing Address - Country:US
Mailing Address - Phone:800-392-1041
Mailing Address - Fax:
Practice Address - Street 1:2190 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5505
Practice Address - Country:US
Practice Address - Phone:800-392-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80539237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist