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General NPI Number Information
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NPI Number | 1144571019
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Entity Type | Individual
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Provider Name | POLLY LAUREL MORGAN LAC
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Gender | Female
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 232 N MAIN ST SUITE 1B
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City | MARYSVILLE
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State | OH
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Zip | 43040-1160
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Country | US
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Telephone | 937-707-9953
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Fax |
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Provider Business Mailing Address
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Address Line | 216 ALDER CT
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City | DELAWARE
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State | OH
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Zip | 43015-2775
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Country | US
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Telephone | 937-707-9953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000150
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License Number State | OH
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