MEDICARE: LOUISE MARIE ETHIER DOM, AP

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	AP 1945	FL

General Provider Information

NPI Number	:	1881655041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE MARIE ETHIER DOM, AP

Provider Business Mailing Address
First Line	:	341 RIBAULT AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118-4750
Country	:	US
Telephone Number	:	386-846-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 S RIDGEWOOD AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-3077
Country	:	US
Telephone Number	:	386-846-0995
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/08/2007

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