Healthcare Provider Details

I. General information

NPI: 1659938348
Provider Name (Legal Business Name): LEA TAM INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LINCOLN STREET SUITE 301
BOSTON MA
02111
US

IV. Provider business mailing address

200 LINCOLN STREET SUITE 301
BOSTON MA
02111
US

V. Phone/Fax

Practice location:
  • Phone: 617-338-6818
  • Fax:
Mailing address:
  • Phone: 617-338-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: YVONNE TAM
Title or Position: MANAGER
Credential: LIC AC
Phone: 617-338-6818