Provider Demographics
NPI:1982802039
Name:MICHAELS, REBEKAH VEEN (MAOM, LIC AC)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:VEEN
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MAOM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNDEE PARK DR
Mailing Address - Street 2:SUITES 1 & 2
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3752
Mailing Address - Country:US
Mailing Address - Phone:978-474-9994
Mailing Address - Fax:978-474-0171
Practice Address - Street 1:1 DUNDEE PARK DR
Practice Address - Street 2:SUITES 1 & 2
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3752
Practice Address - Country:US
Practice Address - Phone:978-474-9994
Practice Address - Fax:978-474-0171
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226462OtherMASSACHSETTS BOARD OF REG