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General NPI Number Information
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NPI Number | 1720257173
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Entity Type | Individual
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Provider Name | MARY ABIGAIL THOMAS-COSTELLO LAC, LMT
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Gender | Female
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 19 E. MAIN STREET
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City | TRUMANSBURG
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State | NY
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Zip | 14886
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Country | US
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Telephone | 607-274-7520
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Fax | 607-274-7520
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Provider Business Mailing Address
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Address Line | PO BOX 386 19 EAST MAIN STREET
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City | TRUMANSBURG
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State | NY
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Zip | 14886-0386
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Country | US
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Telephone | 607-274-7520
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Fax | 607-274-7520
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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 | 25003352
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License Number State | NY
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