Healthcare Provider Details

I. General information

NPI: 1548583958
Provider Name (Legal Business Name): MASSAGECRAFT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 ALFRED ST
BIDDEFORD ME
04005-3102
US

IV. Provider business mailing address

314 ALFRED ST
BIDDEFORD ME
04005-3102
US

V. Phone/Fax

Practice location:
  • Phone: 207-286-8416
  • Fax:
Mailing address:
  • Phone: 207-286-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC209
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT410
License Number StateME

VIII. Authorized Official

Name: LISA ANNE BOUCHARD
Title or Position: OWNER, ACUPUNCTURIST, MASSAGE THERA
Credential: LMT, LAC
Phone: 207-286-8416