=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073756813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTBOUND ACUPUNCTURE LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2009
-----------------------------------------------------
Last Update Date | 04/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 ROSEWOOD AVE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78702-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-506-1608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 ROSEWOOD AVE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78702-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-506-1608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURIST
-----------------------------------------------------
Name | JAMIE LEE SCOTT
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 512-506-1608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 1079
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------