Provider Demographics
NPI:1245712991
Name:MOTTA-WURST, AUDREY (MS)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:MOTTA-WURST
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 MAIN ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2000
Mailing Address - Country:US
Mailing Address - Phone:508-313-9374
Mailing Address - Fax:833-563-2673
Practice Address - Street 1:714 MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2000
Practice Address - Country:US
Practice Address - Phone:508-313-9374
Practice Address - Fax:833-563-2673
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist