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General NPI Number Information
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NPI Number | 1518524891
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Entity Type | Individual
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Provider Name | KATHLEEN COSTELLO L.AC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 301 3RD ST NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4094
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Country | US
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Telephone | 718-344-5709
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Fax |
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Provider Business Mailing Address
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Address Line | 2483 SAINT AUGUSTINE BLVD
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City | HAINES CITY
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State | FL
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Zip | 33844-2420
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Country | US
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Telephone | 718-344-5709
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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 | AP3902
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License Number State | FL
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