Provider Demographics
NPI:1396252714
Name:MARDACH-DUCLERC, OLGA MARIA (MSC LAC, DIPL OM)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:MARIA
Last Name:MARDACH-DUCLERC
Suffix:
Gender:F
Credentials:MSC LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8265
Mailing Address - Country:US
Mailing Address - Phone:802-851-0604
Mailing Address - Fax:
Practice Address - Street 1:1099 COCHRAN RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8265
Practice Address - Country:US
Practice Address - Phone:802-851-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0910133997171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty