Provider Demographics
NPI:1659931061
Name:HOTTIN, MARY AMELIA (AUD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AMELIA
Last Name:HOTTIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:AMELIA
Other - Last Name:LOVELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:115 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4422
Practice Address - Country:US
Practice Address - Phone:401-444-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00272231H00000X
MA4764-SP-AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist