=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508370552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATIVE HEALING ARTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2017
-----------------------------------------------------
Last Update Date | 11/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8850 STANFORD BLVD STE 1800
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-4733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-351-7172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8850 STANFORD BLVD STE 1800
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-4733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-351-7172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ACUPUNCTURIST
-----------------------------------------------------
Name | AMANDA PLECHA
-----------------------------------------------------
Credential | L.AC, M.AC
-----------------------------------------------------
Telephone | 443-351-7172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | U02355
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------