Basic Information
| Provider Information | |||||||||
| NPI: | 1750658175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | HEARING AID DEALER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 931 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | KOKOMO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469015319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654530200 | ||||||||
| FaxNumber: | 7654530220 | ||||||||
| Practice Location | |||||||||
| Address1: | 931 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | KOKOMO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469015319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654530200 | ||||||||
| FaxNumber: | 7654530220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2011 | ||||||||
| LastUpdateDate: | 11/30/2011 | ||||||||
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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 | 17001375A | IN | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.