Healthcare Provider Details

I. General information

NPI: 1366740334
Provider Name (Legal Business Name): CATHERINE L OBRIEN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W 24TH ST STE B
LAWRENCE KS
66046-4417
US

IV. Provider business mailing address

PO BOX 1032
LAWRENCE KS
66044-8032
US

V. Phone/Fax

Practice location:
  • Phone: 785-856-0830
  • Fax:
Mailing address:
  • Phone: 785-979-7094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number584610-09
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: