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Individual
MAGGIE ALINE LANCTOT
Active
Individual
MAGGIE ALINE LANCTOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2000004100
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000004100
BOARD OF CERTIFICATION
CA
Enumeration date
05/18/2016
Last updated
05/18/2016
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