=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881119691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE AWAITS ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2017
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 S TAMIAMI TRAIL
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-366-8383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3920 BEE RIDGE RD STE C-B
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-366-8383
-----------------------------------------------------
Fax | 941-951-1485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KEIKO DODSON
-----------------------------------------------------
Credential | DOM,A.P
-----------------------------------------------------
Telephone | 941-320-7499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP3725
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------