Individual
TANIA A LASLOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.T.C.
Contact information
Practice address
100 EDGARTOWN ROAD, OAK BLUFFS, MA 02557
(508) 693-1033
Mailing address
PO BOX 4012, VINEYARD HAVEN, MA 02568-0928
(508) 693-1033
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1742
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1742
MA AHP LICENSE
MA
01
—
960212
NATA MEMBER DISTRICT 1
MA
Enumeration date
04/27/2007
Last updated
07/08/2007
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