Healthcare Provider Details

I. General information

NPI: 1134750946
Provider Name (Legal Business Name): HEATHER LYNN OBRIEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8219 RIVER COUNTRY DR
SPRING HILL FL
34607
US

IV. Provider business mailing address

470 MERRIMAC LN
SPRING HILL FL
34606-5741
US

V. Phone/Fax

Practice location:
  • Phone: 352-587-7071
  • Fax:
Mailing address:
  • Phone: 352-587-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA79986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: