MEDICARE: VANESSA THELIN-KNOX L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	U02187	MD

General Provider Information

NPI Number	:	1619362886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA THELIN-KNOX L.AC.

Provider Business Mailing Address
First Line	:	4641 MONTGOMERY AVE
Second Line	:	SUITE 40
City	:	BETHESDA
State	:	MD
Zip	:	20814-3488
Country	:	US
Telephone Number	:	301-204-6470
Fax Number	:

Provider Business Practice Location Address
First Line	:	7142 CARROLL AVE APT 3
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-4673
Country	:	US
Telephone Number	:	240-750-0222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	04/03/2015

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