=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811231269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL LETNER LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2012
-----------------------------------------------------
Last Update Date | 12/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2904 OLD OCEAN CITY RD
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-4749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-924-1265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12531 W HWY 71 APT 1108
-----------------------------------------------------
City | BEE CAVE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-6641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-924-1265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | OU1983
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------