Healthcare Provider Details

I. General information

NPI: 1326895608
Provider Name (Legal Business Name): WATER HOUSE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 MASSACHUSETTS AVE STE 3
ARLINGTON MA
02476-4712
US

IV. Provider business mailing address

742 MASSACHUSETTS AVE STE 3
ARLINGTON MA
02476-4712
US

V. Phone/Fax

Practice location:
  • Phone: 781-460-7107
  • Fax:
Mailing address:
  • Phone: 781-460-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY A FITZPATRICK
Title or Position: OWNING MEMBER
Credential:
Phone: 781-460-7107