Healthcare Provider Details

I. General information

NPI: 1821149295
Provider Name (Legal Business Name): LORI G FIELD L AC, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 NE 180TH ST SUITE 100
BOTHELL WA
98011-5773
US

IV. Provider business mailing address

17409 106TH PL NE
BOTHELL WA
98011-3779
US

V. Phone/Fax

Practice location:
  • Phone: 425-443-0831
  • Fax:
Mailing address:
  • Phone: 425-482-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002633
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: