Provider Demographics
NPI:1174841282
Name:WOOLLACOTT, MARIE (LICAC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:WOOLLACOTT
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670R MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3120
Mailing Address - Country:US
Mailing Address - Phone:508-439-9558
Mailing Address - Fax:
Practice Address - Street 1:160 OLD DERBY ST
Practice Address - Street 2:STE 457
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4005
Practice Address - Country:US
Practice Address - Phone:781-741-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist