Provider Demographics
NPI:1932220092
Name:SPELLMAN, LISA W (LIC AC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:W
Last Name:SPELLMAN
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:ANCIENT WISDOM HEALING ARTS
Mailing Address - Street 2:155 BOSTON RD, SUITE 1
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1322
Mailing Address - Country:US
Mailing Address - Phone:508-460-0444
Mailing Address - Fax:
Practice Address - Street 1:ANCIENT WISDOM HEALING ARTS
Practice Address - Street 2:155 BOSTON RD, SUITE 1
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1322
Practice Address - Country:US
Practice Address - Phone:508-460-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist