MEDICARE: HEALING LIGHT ACUPUNCTURE, INC.

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

General Provider Information

NPI Number	:	1629627419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING LIGHT ACUPUNCTURE, INC.

Provider Business Mailing Address
First Line	:	4 KELLOGG RD STE 6
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-2815
Country	:	US
Telephone Number	:	802-662-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 KELLOGG RD STE 6
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-2815
Country	:	US
Telephone Number	:	802-662-5882
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ACUPUNCTURIST
Name	:	KIMBERLY A KRAUSE
Credential	:	MAOM
Telephone Number	:	802-662-5882

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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