Provider Demographics
NPI:1952346421
Name:BRESNAN, MARIA TERESA MACLEAN (DOM, LAC)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:MACLEAN
Last Name:BRESNAN
Suffix:
Gender:F
Credentials:DOM, LAC
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 761
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0026
Mailing Address - Country:US
Mailing Address - Phone:541-601-3014
Mailing Address - Fax:541-201-0047
Practice Address - Street 1:1117 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7404
Practice Address - Country:US
Practice Address - Phone:541-601-3014
Practice Address - Fax:541-201-0047
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR ACOO437171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226553Medicaid