Provider Demographics
NPI:1134296874
Name:WACLAWIK, LAURICE H (LIC AC)
Entity Type:Individual
Prefix:
First Name:LAURICE
Middle Name:H
Last Name:WACLAWIK
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RALYN RD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-3041
Mailing Address - Country:US
Mailing Address - Phone:508-748-2700
Mailing Address - Fax:
Practice Address - Street 1:345 FRONT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1537
Practice Address - Country:US
Practice Address - Phone:508-748-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist