Provider Demographics
NPI:1174010953
Name:MACLAREN, TESLIN EMORY SKY (LAC, LMT)
Entity Type:Individual
Prefix:MISS
First Name:TESLIN
Middle Name:EMORY SKY
Last Name:MACLAREN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81235-0594
Mailing Address - Country:US
Mailing Address - Phone:970-739-4435
Mailing Address - Fax:
Practice Address - Street 1:811 HIGHWAY 149
Practice Address - Street 2:UNIT 6
Practice Address - City:LAKE CITY
Practice Address - State:CO
Practice Address - Zip Code:81235
Practice Address - Country:US
Practice Address - Phone:970-739-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022456225700000X
COACU.0002469171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist