Provider Demographics
NPI:1730338328
Name:THOMASON, SANDRA KIM (LAC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KIM
Last Name:THOMASON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 FRONT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-5834
Mailing Address - Country:US
Mailing Address - Phone:207-778-9700
Mailing Address - Fax:
Practice Address - Street 1:193 FRONT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-5834
Practice Address - Country:US
Practice Address - Phone:207-778-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist