Provider Demographics
NPI:1699915652
Name:LAU, MARJORIE H (LIC AC, MAC)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:H
Last Name:LAU
Suffix:
Gender:F
Credentials:LIC AC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO 1456
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568
Mailing Address - Country:US
Mailing Address - Phone:508-693-2776
Mailing Address - Fax:508-693-2776
Practice Address - Street 1:58 BRIARWOOD LANE
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-2776
Practice Address - Fax:508-693-2776
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist