| Organization Name: | KOOTENAI AUDIOLOGY, LLC |
| NPI Number: | 1073821542 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT C FARR (OWNER) |
| Mailing Address: | 700 W Ironwood Dr Suite 236 Coeur D Alene |
| State: | ID US |
| Postal Code: | 838142656 |
| Phone Number: | 2087651345 |
| Fax Number: | 2086679622 |
| NPI Enumeration Date: | 09/18/2010 |
| NPI Last Update Date: | 09/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 231HA2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Audiologist |
| Taxonomy Specialization: | Assistive Technology Supplier |
| Taxonomy Definition: | |