MEDICARE: MS. CAROL RUTH HETHERINGTON LICAC

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	245660	MA
2	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1861710337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL RUTH HETHERINGTON LICAC

Provider Business Mailing Address
First Line	:	31 HAYWARD STREET
Second Line	:	SUITE C-2
City	:	FRANKLIN
State	:	MA
Zip	:	02038-2166
Country	:	US
Telephone Number	:	401-528-9980
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 HAYWARD STREET
Second Line	:	SUITE C-2
City	:	FRANKLIN
State	:	MA
Zip	:	02038-2166
Country	:	US
Telephone Number	:	401-528-9980
Fax Number	:

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

Provider Enumeration Date	:	05/09/2010
Last Update Date	:	11/04/2024

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