Provider Demographics
NPI:1811231269
Name:LETNER, CAROL (LAC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LETNER
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 1:12531 W HWY 71 APT 1108
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6641
Mailing Address - Country:US
Mailing Address - Phone:512-924-1265
Mailing Address - Fax:
Practice Address - Street 1:2904 OLD OCEAN CITY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4749
Practice Address - Country:US
Practice Address - Phone:512-924-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDOU1983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist