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General NPI Number Information
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NPI Number | 1972863769
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Entity Type | Individual
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Provider Name | REBECCA DOUGLASS L.AC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 10109 DAVIS AVE
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City | GRANITE
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State | MD
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Zip | 21163-1226
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Country | US
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Telephone | 410-440-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 14354 TRIADELPHIA MILL RD
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City | DAYTON
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State | MD
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Zip | 21036-1222
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Country | US
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Telephone |
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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 | U01319
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License Number State | MD
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