Basic Information
| Provider Information | |||||||||
| NPI: | 1093266736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIBELBEK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | HARTER | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 S PATTERSON BLVD | ||||||||
| Address2: | STE 400 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454022642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374962620 | ||||||||
| FaxNumber: | 9374248518 | ||||||||
| Practice Location | |||||||||
| Address1: | 6601 CENTERVILLE BUSINESS PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454592691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374962600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 12/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | A.02034 | OH | Y | Speech, Language and Hearing Service Providers | Audiologist | 231HA2400X | A.02034 | OH | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2500X | A.02034 | OH | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 237600000X | A.02034 | OH | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.