Healthcare Provider Details

I. General information

NPI: 1982802039
Provider Name (Legal Business Name): REBEKAH VEEN MICHAELS MAOM, LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNDEE PARK DR SUITES 1 & 2
ANDOVER MA
01810-3752
US

IV. Provider business mailing address

1 DUNDEE PARK DR SUITES 1 & 2
ANDOVER MA
01810-3752
US

V. Phone/Fax

Practice location:
  • Phone: 978-474-9994
  • Fax: 978-474-0171
Mailing address:
  • Phone: 978-474-9994
  • Fax: 978-474-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number226462
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: