MEDICARE: TRACI J PUCKETT LIC. AC.

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	221023	MA

General Provider Information

NPI Number	:	1528222783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI J PUCKETT LIC. AC.

Provider Business Mailing Address
First Line	:	362A LONG PLAIN RD
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-9642
Country	:	US
Telephone Number	:	413-387-7035
Fax Number	:

Provider Business Practice Location Address
First Line	:	53A S MAIN ST
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-1027
Country	:	US
Telephone Number	:	413-387-7035
Fax Number	:

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	07/16/2008

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