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General NPI Number Information
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NPI Number | 1003331372
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Entity Type | Individual
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Provider Name | TARA LYNN DAVIS L.AC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 3663 COLLEGE ST SE STE F
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City | LACEY
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State | WA
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Zip | 98503-2303
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Country | US
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Telephone | 253-265-5116
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Fax |
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Provider Business Mailing Address
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Address Line | 2574 BIRCH CT
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City | MILTON
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State | WA
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Zip | 98354-9354
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60742084
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License Number State | WA
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