Provider Demographics
NPI:1508042144
Name:TAMILO-AWED, KATHLEEN (LIC AC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:TAMILO-AWED
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 1:465 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1230
Mailing Address - Country:US
Mailing Address - Phone:508-754-0211
Mailing Address - Fax:
Practice Address - Street 1:ACUPUNCTURE ASSOCIATES OF WORCESTER
Practice Address - Street 2:465 PARK AVENUE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-754-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist