Provider Demographics
NPI:1346727302
Name:WATERFIELD WELLNESS LLC
Entity Type:Organization
Organization Name:WATERFIELD WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:TURCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:339-645-0532
Mailing Address - Street 1:10 CEDAR ST STE 24
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6365
Mailing Address - Country:US
Mailing Address - Phone:339-645-0532
Mailing Address - Fax:
Practice Address - Street 1:10 CEDAR ST STE 24
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6365
Practice Address - Country:US
Practice Address - Phone:339-645-0532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265188171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871976159OtherPERSONAL NPI NUMBER