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General NPI Number Information
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NPI Number | 1891932828
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Entity Type | Organization
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Legal Business Name | WOODLAND BRAE WELLNESS
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 252 E 6TH ST
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City | FREDERICK
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State | MD
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Zip | 21701-5220
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Country | US
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Telephone | 301-874-9095
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Fax | 301-874-9096
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Provider Business Mailing Address
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Address Line | 9341 DOCTOR PERRY RD
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City | IJAMSVILLE
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State | MD
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Zip | 21754-8724
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Country | US
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Telephone | 301-874-9095
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Fax | 301-874-9096
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BETH G. OWENS
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Credential | DIPL. AC., L. AC.
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Telephone | 301-874-9095
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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 | U0509
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License Number State | MD
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