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General NPI Number Information
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NPI Number | 1669896486
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Entity Type | Individual
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Provider Name | THERESE B. HAZELTINE LMT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 3795 ALT 19 # A1
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City | PALM HARBOR
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State | FL
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Zip | 34683-1400
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Country | US
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Telephone | 727-271-4383
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Fax |
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Provider Business Mailing Address
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Address Line | 7954 ADEN LOOP
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-2724
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Country | US
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Telephone | 727-271-4383
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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 | 175L00000X
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Taxonomy Name | Homeopath
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License Number | MA46785
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License Number State | FL
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