Provider Demographics
NPI:1740450519
Name:WAITE, TAMMY LORA (TAMMY WAITE, LIC AC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LORA
Last Name:WAITE
Suffix:
Gender:F
Credentials:TAMMY WAITE, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROWLAND CT
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2338
Mailing Address - Country:US
Mailing Address - Phone:781-639-0708
Mailing Address - Fax:781-639-0708
Practice Address - Street 1:5 ROWLAND CT
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2338
Practice Address - Country:US
Practice Address - Phone:781-639-0708
Practice Address - Fax:781-639-0708
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist