Provider Demographics
NPI:1962850909
Name:COOLEY, LAURA ELLEN (LAC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELLEN
Last Name:COOLEY
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 1:22 FORREST TALLMAN RD
Mailing Address - Street 2:
Mailing Address - City:ORFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03777-4615
Mailing Address - Country:US
Mailing Address - Phone:603-276-9158
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:#206
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4257
Practice Address - Country:US
Practice Address - Phone:603-276-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT118171100000X
TX115171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist