Provider Demographics
NPI:1770189870
Name:EMOND, KATHLENE TIMOTEO (LAC)
Entity Type:Individual
Prefix:
First Name:KATHLENE
Middle Name:TIMOTEO
Last Name:EMOND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-4263
Mailing Address - Country:US
Mailing Address - Phone:860-977-2909
Mailing Address - Fax:
Practice Address - Street 1:896 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-4263
Practice Address - Country:US
Practice Address - Phone:860-977-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT781171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty