=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285824326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA S GRAY LIC. AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2007
-----------------------------------------------------
Last Update Date | 07/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 UNION ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03055-4875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-673-1303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 OLD ASHBY RD
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03048-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-673-1303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 216128
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------