Provider Demographics
NPI:1811213135
Name:OGLESBY, LAURA K (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:OGLESBY
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 1:11448 DEERFIELD DR STE 2
Mailing Address - Street 2:160
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0518
Mailing Address - Country:US
Mailing Address - Phone:530-414-3489
Mailing Address - Fax:
Practice Address - Street 1:695 WOLF STREET
Practice Address - Street 2:
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143
Practice Address - Country:US
Practice Address - Phone:530-546-8201
Practice Address - Fax:530-546-8205
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13293171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist