Provider Demographics
NPI:1891932828
Name:WOODLAND BRAE WELLNESS
Entity Type:Organization
Organization Name:WOODLAND BRAE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL AC, L AC
Authorized Official - Phone:301-874-9095
Mailing Address - Street 1:9341 DOCTOR PERRY RD
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-8724
Mailing Address - Country:US
Mailing Address - Phone:301-874-9095
Mailing Address - Fax:301-874-9096
Practice Address - Street 1:252 E 6TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5220
Practice Address - Country:US
Practice Address - Phone:301-874-9095
Practice Address - Fax:301-874-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU0509171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty