Provider Demographics
NPI:1134269780
Name:PURCELL, ORLAND (AUD)
Entity type:Individual
Prefix:
First Name:ORLAND
Middle Name:
Last Name:PURCELL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N MIDLAND DR STE 4
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5593
Mailing Address - Country:US
Mailing Address - Phone:432-689-4327
Mailing Address - Fax:432-689-4329
Practice Address - Street 1:2101 N MIDLAND DR STE 4
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5593
Practice Address - Country:US
Practice Address - Phone:432-689-4327
Practice Address - Fax:432-689-4329
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50480231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1729121Medicaid
TX1729121Medicaid