Provider Demographics
NPI:1922602523
Name:KLOTZ, LAURA LEE (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:KLOTZ
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 1:104 E CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-8712
Mailing Address - Country:US
Mailing Address - Phone:352-536-4992
Mailing Address - Fax:352-218-1613
Practice Address - Street 1:838 W DESOTO ST STE 4D
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2110
Practice Address - Country:US
Practice Address - Phone:352-536-4992
Practice Address - Fax:352-218-1613
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist