Provider Demographics
NPI:1184871931
Name:LOOMIS, KATHRYN (LAC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LOOMIS
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 1:260 BOSTON POST RD
Mailing Address - Street 2:#10
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1889
Mailing Address - Country:US
Mailing Address - Phone:508-358-8988
Mailing Address - Fax:
Practice Address - Street 1:260 BOSTON POST RD
Practice Address - Street 2:#10
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1889
Practice Address - Country:US
Practice Address - Phone:508-358-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000007171100000X
MA238444171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist