Healthcare Provider Details

I. General information

NPI: 1861981961
Provider Name (Legal Business Name): OWLFEATHER HOLISTIC MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E PATRICK ST
FREDERICK MD
21701-5677
US

IV. Provider business mailing address

7 MAIN ST
WALKERSVILLE MD
21793-8640
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 Number
License Number State

VIII. Authorized Official

Name: STEPHANIE OWLFEATHER
Title or Position: OWNER
Credential: L.AC
Phone: 240-405-8289