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General NPI Number Information
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NPI Number | 1851044556
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Entity Type | Individual
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Provider Name | ALISSA IDE-MOTTA L.AC.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 28 WATER ST
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City | DAMARISCOTTA
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State | ME
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Zip | 04543-4080
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Country | US
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Telephone | 207-563-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 27 CROSBY ST APT 3
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City | AUGUSTA
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State | ME
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Zip | 04330-4557
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Country | US
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Telephone | 626-429-6490
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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 | AC
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License Number State | ME
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