MEDICARE: KATHLENE TIMOTEO EMOND LAC

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	171100000X	Acupuncturist	781	CT

General Provider Information

NPI Number	:	1770189870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLENE TIMOTEO EMOND LAC

Provider Business Mailing Address
First Line	:	896 PLEASANT VALLEY RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-4263
Country	:	US
Telephone Number	:	860-977-2909
Fax Number	:

Provider Business Practice Location Address
First Line	:	896 PLEASANT VALLEY RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-4263
Country	:	US
Telephone Number	:	860-977-2909
Fax Number	:

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

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	12/05/2020

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Directions to “ KATHLENE TIMOTEO EMOND LAC” Practice Location

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