Provider Demographics
NPI:1396342374
Name:SCHATZ, LAURA WOLF (MSTOM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:WOLF
Last Name:SCHATZ
Suffix:
Gender:F
Credentials:MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 NORTH COURT ST
Practice Address - Street 2:FRONT NW UNIT
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-0290
Practice Address - Country:US
Practice Address - Phone:860-670-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006605171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist