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General NPI Number Information
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NPI Number | 1649500034
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Entity Type | Individual
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Provider Name | SHELLEY ALLISON SOVOLA L.AC.,OMD
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Gender | Female
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 1303 NORTHCREST DR
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City | CRESCENT CITY
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State | CA
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Zip | 95531-2322
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Country | US
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Telephone | 707-465-3000
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Fax | 541-469-2180
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Provider Business Mailing Address
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Address Line | PO BOX 6969
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City | BROOKINGS
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State | OR
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Zip | 97415-0355
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Country | US
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Telephone | 541-469-3354
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Fax | 541-469-2180
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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 | AC1181
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License Number State | CA
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