Provider Demographics
NPI:1760752372
Name:LEE, EMMA WHITEOAK (MACOM)
Entity Type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:WHITEOAK
Last Name:LEE
Suffix:
Gender:F
Credentials:MACOM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3976 HINESBURG RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-4468
Mailing Address - Country:US
Mailing Address - Phone:802-579-4473
Mailing Address - Fax:
Practice Address - Street 1:62 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3208
Practice Address - Country:US
Practice Address - Phone:802-251-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0066536171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist