Healthcare Provider Details

I. General information

NPI: 1285183293
Provider Name (Legal Business Name): STEPHANIE OWLFEATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 N MARKET ST
FREDERICK MD
21701-5337
US

IV. Provider business mailing address

332 N MARKET ST
FREDERICK MD
21701-5337
US

V. Phone/Fax

Practice location:
  • Phone: 240-405-8289
  • Fax:
Mailing address:
  • Phone: 240-405-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02341
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: