Provider Demographics
NPI:1568759603
Name:O'CONNOR, ELLEN FRANCES (MAC LAC LMT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:FRANCES
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MAC LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-1236
Mailing Address - Country:US
Mailing Address - Phone:207-563-1741
Mailing Address - Fax:
Practice Address - Street 1:10 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-1236
Practice Address - Country:US
Practice Address - Phone:207-563-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist