MEDICARE: MR. THOMAS JOHN LECLAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZA2600X	Medical Art Specialist/Technologist		MA

General Provider Information

NPI Number	:	1073725826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JOHN LECLAIR

Provider Business Mailing Address
First Line	:	PO BOX 52
Second Line	:
City	:	BECKET
State	:	MA
Zip	:	01223-0052
Country	:	US
Telephone Number	:	413-623-6472
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 ALGERIE ROAD
Second Line	:
City	:	BECKET
State	:	MA
Zip	:	01223
Country	:	US
Telephone Number	:	413-623-6472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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