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General NPI Number Information
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NPI Number | 1871035139
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Entity Type | Individual
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Provider Name | KALLIE GUIMOND OMD
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Gender | Female
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 263 W PATRICK ST SUITE 2
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City | FREDERICK
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State | MD
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Zip | 21701-6910
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Country | US
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Telephone | 240-432-7522
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 LEW WALLACE ST
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City | FREDERICK
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State | MD
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Zip | 21704-7872
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Country | US
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Telephone | 240-432-7522
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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 | U02186
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License Number State | MD
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