Provider Demographics
NPI:1154628378
Name:BLANCHARD, PAULA (LIC AC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1863
Mailing Address - Country:US
Mailing Address - Phone:978-486-0260
Mailing Address - Fax:
Practice Address - Street 1:29 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460
Practice Address - Country:US
Practice Address - Phone:978-486-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist