MEDICARE: AUTUMN SNAVELY LAC,LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	65.000333	OH

General Provider Information

NPI Number	:	1194217018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN SNAVELY LAC,LSW

Provider Business Mailing Address
First Line	:	5340 BILBERRY LN
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1496 OLD HENDERSON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3614
Country	:	US
Telephone Number	:	614-270-4735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/06/2018

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