Provider Demographics
NPI:1659604171
Name:WUOTILA, ANDREA LYNNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNNE
Last Name:WUOTILA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WASHINGTON ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1100
Mailing Address - Country:US
Mailing Address - Phone:781-255-7080
Mailing Address - Fax:
Practice Address - Street 1:105 WASHINGTON ST
Practice Address - Street 2:STE 4
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1100
Practice Address - Country:US
Practice Address - Phone:781-255-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor