Provider Demographics
NPI:1942322623
Name:EARTECH INC
Entity Type:Organization
Organization Name:EARTECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KRYWKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-747-8193
Mailing Address - Street 1:3904 9TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1704
Mailing Address - Country:US
Mailing Address - Phone:941-747-8193
Mailing Address - Fax:
Practice Address - Street 1:3904 9TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1704
Practice Address - Country:US
Practice Address - Phone:941-747-8193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY549231HA2400X
FLSA2294235Z00000X
FLAS0002378237700000X
FLAS0002885237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ0639OtherHEARING,AUDIOLOGY
FLK1360Medicare ID - Type UnspecifiedAUDIOLOGY