Individual ProviderTina SampleAudiologistSpeech, Language and Hearing Service ProvidersPractice Address3085 W Market St Ste 102, Fairlawn, OH 44333-3620(330) 379-9070PECOS EnrollmentBased on the most recent information from CMS, provider Tina Sample does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1871879890Provider TypeIndividualFull NameSample, TinaTitleDr.CredentialAUDGenderFemaleSole ProprietorNoEnumeration Date10/24/2011Last Updated1/31/2026Contact InformationPractice LocationPractice Address3085 W Market St Ste 102, Fairlawn, OH 44333-3620Phone(330) 379-9070Fax(330) 379-2358Mailing LocationMailing Address3085 W Market St Ste 102, Fairlawn, OH 44333-3620Phone(330) 379-9070Fax(330) 379-2358Provider TaxonomiesCodeDescriptionLicenseCode231H00000XPrimaryDescriptionAudiologistSpeech, Language and Hearing Service ProvidersLicenseA. 01352Ohio