Healthcare Provider Details

I. General information

NPI: 1225326739
Provider Name (Legal Business Name): INTEGRATIVE ACUPUNCTURE AND ORIENTAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELM ST
MONTPELIER VT
05602-2205
US

IV. Provider business mailing address

200 ELM ST
MONTPELIER VT
05602-2205
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-0954
  • Fax: 802-223-6057
Mailing address:
  • Phone: 802-223-0954
  • Fax: 802-223-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0910000203
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: VANESSA LENO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 802-223-0954