Healthcare Provider Details

I. General information

NPI: 1811258361
Provider Name (Legal Business Name): CAROLE WYCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 NAHATAN ST
NORWOOD MA
02062
US

IV. Provider business mailing address

431 NAHATAN ST
NORWOOD MA
02062-1406
US

V. Phone/Fax

Practice location:
  • Phone: 508-207-8378
  • Fax:
Mailing address:
  • Phone: 508-207-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: