Healthcare Provider Details

I. General information

NPI: 1730234022
Provider Name (Legal Business Name): CAROL ANN OTOOLE L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 KIELWASSER RD
WASHINGTON DEPOT CT
06794-1120
US

IV. Provider business mailing address

46 KIELWASSER RD
WASHINGTON DEPOT CT
06794-1120
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-1615
  • Fax: 860-868-1618
Mailing address:
  • Phone: 860-868-1615
  • Fax: 860-868-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000194
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: