Provider Demographics
NPI:1366613739
Name:POULTER, TANNYA E (MS)
Entity type:Individual
Prefix:
First Name:TANNYA
Middle Name:E
Last Name:POULTER
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 1:6 COLEBROOK BLVD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-2067
Mailing Address - Country:US
Mailing Address - Phone:781-523-1641
Mailing Address - Fax:
Practice Address - Street 1:6 COLEBROOK BLVD
Practice Address - Street 2:UNIT 7
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-2067
Practice Address - Country:US
Practice Address - Phone:781-523-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA680231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO 025064Medicare PIN