Provider Demographics
NPI:1811162993
Name:OCONNELL NEVARD, ALLYSON (LAC)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:OCONNELL NEVARD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:NEVARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:730 BOSTON POST RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3368
Mailing Address - Country:US
Mailing Address - Phone:508-740-1424
Mailing Address - Fax:978-443-4498
Practice Address - Street 1:730 BOSTON POST RD
Practice Address - Street 2:SUITE 28
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3368
Practice Address - Country:US
Practice Address - Phone:508-740-1424
Practice Address - Fax:978-443-4498
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222896171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist