Healthcare Provider Details

I. General information

NPI: 1699184242
Provider Name (Legal Business Name): WIND IN THE WILLOWS ACUPUNCTURE & TRADITIONAL CHINESE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 6TH ST SUITE 102
BLAWNOX PA
15238-3238
US

IV. Provider business mailing address

237 6TH ST SUITE 102
BLAWNOX PA
15238-3238
US

V. Phone/Fax

Practice location:
  • Phone: 508-364-4828
  • Fax:
Mailing address:
  • Phone: 508-364-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAK001140
License Number StatePA

VIII. Authorized Official

Name: MRS. MICHELLE DEPERSIS WHEELER
Title or Position: LICENSED ACUPUNCTURIST/OWNER
Credential: L.AC
Phone: 508-364-4828