Basic Information
| Provider Information | |||||||||
| NPI: | 1538496609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPETZ | ||||||||
| FirstName: | BRADY | ||||||||
| MiddleName: | ALVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10570 SE WASHINGTON ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032576800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 CEDARWOOD OFFICE PARK | ||||||||
| Address2: | |||||||||
| City: | FAIRPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852237322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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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 | 237700000X | 14000027820 | NY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.