Provider Demographics
NPI:1659384857
Name:COLTHARP MORTON, LORETTA (AUD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:COLTHARP MORTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LORETTA
Other - Middle Name:J
Other - Last Name:COLTHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5108 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3164
Mailing Address - Country:US
Mailing Address - Phone:901-372-0040
Mailing Address - Fax:901-372-8685
Practice Address - Street 1:5118 STAGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3166
Practice Address - Country:US
Practice Address - Phone:901-372-0040
Practice Address - Fax:901-372-8685
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA103231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I642911OtherMEDICARE PTAN
TN103I642911OtherMEDICARE PTAN