=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982026142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARINA LAWSON LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2014
-----------------------------------------------------
Last Update Date | 08/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7105 S HIGHLAND DR SUITE 202
-----------------------------------------------------
City | COTTONWOOD HEIGHTS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84121-3753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-490-1979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8566 S KINGS COVE DR
-----------------------------------------------------
City | COTTONWOOD HEIGHTS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84121-6006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-490-1979
-----------------------------------------------------
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 | 8836290-1201
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------