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General NPI Number Information
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NPI Number | 1407826076
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Entity Type | Individual
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Provider Name | TERESA TAT MAOM
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 2014 FAIRMOUNT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2602
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Country | US
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Telephone | 267-687-5655
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N 20TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2005
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Country | US
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Telephone | 267-687-5655
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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 | OM000058
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License Number State | PA
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