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General NPI Number Information
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NPI Number | 1770951063
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Entity Type | Organization
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Legal Business Name | QUIET CORNER ACUPUNCTURE
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 24 S MAIN ST
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City | PUTNAM
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State | CT
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Zip | 06260-1906
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Country | US
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Telephone | 860-315-9272
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Fax | 860-315-9280
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Provider Business Mailing Address
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Address Line | 24 S MAIN ST
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City | PUTNAM
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State | CT
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Zip | 06260-1906
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Country | US
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Telephone | 860-315-9272
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Fax | 860-315-9280
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Authorized Official
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Title or Position | OWNER/ ACUPUNCTURIST
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Name | GABRIEL KESSELMAN
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Credential | L.AC, DILP OM
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Telephone | 860-315-9272
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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 | 600
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License Number State | CT
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