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General NPI Number Information
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NPI Number | 1104172386
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Entity Type | Organization
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Legal Business Name | ISLAND WELLNESS
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 12701 OVERSEAS HWY
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City | MARATHON
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State | FL
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Zip | 33050-3538
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Country | US
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Telephone | 352-519-7461
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Fax | 305-289-9332
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Provider Business Mailing Address
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Address Line | 12701 OVERSEAS HWY
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City | MARATHON
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State | FL
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Zip | 33050-3538
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Country | US
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Telephone | 352-519-7461
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Fax | 305-289-9332
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Authorized Official
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Title or Position | OWNER, ACUPUNCTURIST
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Name | ANGELA MICHELLE MARCEY
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Credential | AP
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Telephone | 352-519-7461
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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 | AP 3011
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License Number State | FL
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