Provider Demographics
NPI:1871661611
Name:BELANGER, TAMMY E (LIC AC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:E
Last Name:BELANGER
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:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-0043
Mailing Address - Country:US
Mailing Address - Phone:508-228-7577
Mailing Address - Fax:
Practice Address - Street 1:ALTERNATIVE THERAPY
Practice Address - Street 2:37 OLD SOUTH ROAD
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554
Practice Address - Country:US
Practice Address - Phone:508-228-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist